Appendicitis

Question 1

Why is appendicitis a medical emergency?

Answer 1

• It is inflammation of the appendix that can lead to ischaemia, oedema, necrosis and perforation—-> widespread peritonitis
• abscess

Question 2

What causes appendicitis?

Answer 2

‘lumen obstruction due to lymphoid hyperplasia, faecolith or filarial worms

Question 3

what is the presenting complaints of appendicitis?

Answer 3

• Periumbical pain that moved to Right Iliac Fossa.
• anorexia
• constipation
• diarrhoea
• vomiting

Question 4

How does appendicitis present in children?

Answer 4

• vague abdo pain - won’t eat favourite food

Other symptoms can confuse diagnosis of appendicitis:
- fever
- pallor
- abdo distension
-

Question 5

how does appendicitis present in elderly?

Answer 5

• shocked
• confused
• no pain

Question 6

What is McBurney’s point?

Answer 6

Mcburney’s point is 2/3rd from the umbilicus to the right asis. Pain settles here in appendicitis.

Question 7

What aggravates pain in appendicitis?

Answer 7

movement and coughing

Question 8

How does pain change in appendicitis?

Answer 8

1) Gradual onset of poorly localised pain (umbilical region)

2) pain moves to right iliac fossa becomes sharper, constant and well localised.

Question 9

When do patients normally present with appendicitis?

Answer 9

within 24hrs of onset of symptoms

Question 10

what examination finding usually confirms the diagnosis of appendicitis?

Answer 10

• tenderness and guarding in right iliac fossa

Question 11

What are the examination signs of appendicitis?

Answer 11

• tenderness and guarding in RIF
• furring of tongue
• flushed
• mild fever
• lying still
• shallow breath
• bad smell
• hurts to cough
• rebound tenderness
• percurssion tenderness
• Rovsing’s sign
• psoas stretch sign

Question 12

on examination Rovsing’s sign may be present in appendicitis - what is Rovsing’s sign?

Answer 12

Palpation in LIF may produce pain in the RI.

Question 13

Psoas stretch sign may be present in appendicitis -what is this?

Answer 13

paainful to extend right right hip owing to irritation of psoas muscle

Question 14

What are the differentials of acute appendicitis?

Answer 14

GI:

• Mesenteric Adenitis
• Meckel’s diverticulitis
• Crohn’s
• Carcinoma of caecum
• perforated ulcer

Gynae:

• Ruptured ovarian follicle
• acute salpingitis
• ectopic pregnancy
• torsion of ovarian cyst

Urinary:

• Pyelonephritis
• Ureteric colic
• UTI
• Right sided testicular torsion

Question 15

what invx are done for appendicitis?

Answer 15

• Pregnancy test
• Urine analysis (microscopic haematuria and proteinuria)

Bloods :

• FBC (raised neuts)
• CRP/ ESR raised

USS

CT (if unsure)

Question 16

What is the management of appendicitis?

Answer 16

• laparoscopic appendicectomy

- prophylactic antibiotics
Metronidazole and cefuroxime IV