Appendicitis

Question 1

What is appendicitis

Answer 1

Inflammation of the appendix

Question 2

How common is it

Answer 2

most common surgical emergency - 6% lifetime incidence

Question 3

What is the pathophysiology involved in it

Answer 3

• Sudden inflammation appendix –> usually caused by obstruction of lumen
• Gut organism invade wall –> inflamed + infected
• Rupture –> infected + faecal matter into peritoneal cavity –> peritonitis

Question 4

What are the symptoms in appendicitis

Answer 4

• Initially umbilical pain
• Then RIF pain (when peritoneum = inflamed)
• Anorexia, nausea, vomiting
• diarrhoea (sometimes)
• constipation
• Pain on coughing
• PR = pain on right

Question 5

What are the signs of appendicitis

Answer 5

• tachycardia
• Fever
• tenderness + guarding in RIF - migrating pain
• REBOUND TENDERNESS - McBURNEY’S POINT
• ROVSING’S SIGN - press LIF = more pain in right
• PSOAS test = flex hip against pressure
• OBTURATOR test = flex + internally rotate hip

Question 6

What are some differential Dx

Answer 6

• Cholecystitis
• Diverticulitis
• Crohn’s
• Perforated ulcers
• Food poisoning
• Ectopic pregnancy
• Cystitis

Question 7

What investigations would you perform

Answer 7

• Urinalysis - rule out UTI
• Pregnancy test - rule out ectopic preg
• FBC - mild leukocytosis
• Inflammatory markers ^^ (CRP)
• USS

Question 8

How do you treat appendicitis

Answer 8

• Surgery - appendectomy

- cefuroxime + metronidazole IV - pre-op –> prevent wound infection