Appendicitis

Question 1

Signs and symptoms of acute appendicitis

Answer 1

• Fever (low grade unless perforation )
• migratory abdominal pain: peri umbilical → mcburney’s. Constant, dull
• rigidity
• anorexia / nausea/vomiting

Question 2

Atypical locations of appendix and associated signs

Answer 2

• Inferior appendix → mcburneys, rovsig’s (palpation of llq causes mcburney’s pain)
• retrocecal appendix → psoas sign (flexion of hip against resistance, passive hyper extension of hip )
• pelvic appendix → obturator sign (flexion then external or internal rotation of R. Hip elicits pain

Question 3

Investigations to confirm acute appendicitis

Answer 3

• ↑ WBC with left shift
• beta HCG in females of reproductive age
• u/s abdomen
• ct abdomen → thick wall, appendicolith (after u/s)
• air → air under diaphragm if perforated close of psoas shadow

Question 4

What clinical score is used for children presenting to Er with sx suggestive of appendicitis

Answer 4

PALabS scare for children 2-14, score less than or equal to 6 → appendicitis unlikely.

• crp > 10 mg/l →2
• nausea →3
• calprotectin > 0.5 ng/ml →3
• focal RLQ pain → 4
• WBC > 10 x → 4
• ANC (neutrophils) > 7500 →7

Question 5

Management of acute appendicitis

Answer 5

• Iv fluids
• surgery (laparoscopic or open)
• Abx (ampicillin + gentamicin + metronidazole ) x24hr

Question 6

Complications of acute appendicitis

Answer 6

Perforation ( >24 hr ↑ risk ), abscess, phlegmon
Surgical complications → spill bowel content, fistula, pelvic abscess