Appendicitis

Question 1

What is the appendix?

Answer 1

small, thin tube of bowel sprouting from the caecum

Question 2

What causes appendicitis?

Answer 2

Results from obstruction of the appendix and subsequent infection and inflammation of the appendix

Question 3

Peak incidence

Answer 3

ages 10-20

Question 4

Symptoms

Answer 4

• Abdominal pain, typically central then settling in the right iliac fossa (RIF)
• Loss of appetite (anorexia), nausea and vomiting.

Question 5

Signs

Answer 5

• Tender to McBurney’s point (1/3 the distance from the ASIS to umbilicus)
• Guarding to RIF
• Rebound tenderness (increased pain when releasing deep palpation to the RIF) and percussion tenderness indicate peritonitis
• Rovsing’s sign (palpation of the left iliac fossa (LIF) causes pain in the RIF)

Question 6

Diagnosing

Answer 6

• Diagnosis is mostly clinical based on signs and raised inflammatory markers
• CT can be useful in confirming diagnosis in confirming the diagnosis, particularly where other diagnosis more likely
• USS can be useful in women to exclude ovarian and gynae pathology
• If clinically appendicitis but tests are negative may proceed to diagnostic laparoscopy – appendicectomy

Question 7

Differentials

Answer 7

•Ectopic pregnancy (in women of childbearing age) ◦Gynecological emergency with relatively high mortality if mismanaged
◦Essential to get a serum bHCG to exclude pregnancy / ectopic

•Ovarian cysts (with torsion or rupture)

•Meckel’s diverticulitis ◦Malformation of the distal ileum in 2% of the population
◦Can become inflamed and infected in the same way as the appendix

•Mesenteric Adenitis (usually in younger patients) ◦Abdominal pain caused by inflamed abdominal lymph nodes
◦Often associated with cough/cold
◦No treatment required

Question 8

What is an appendix mass?

Answer 8

• Signs of appendicitis with palpable mass in RIF
• When the omentum and / or bowel surround and stick to the inflamed appendix
• Typically managed conservatively with supportive treatment and antibiotics, with appendicectomy once acute condition has resolved

Question 9

How do you treat appendicitis?

Answer 9

• Definitive management for acute appendicitis

* Laparoscopic is associated with fewer risks and faster recovery versus open

Question 10

Complications of appendectomy?

Answer 10

◦Bleeding / infection / pain / scars
◦Damage to bowel, bladder or other organs
◦Removal of normal appendix
◦Anaesthetic risk
◦DVT / PE