Appendicitis

Question 1

Define appendicitis?

Answer 1

Inflammation of the appendix

Question 2

aetiology of appendicitis?

Answer 2

• Gut organisms invade the appendix wall after lumen obstruction
  eg. lymphoid hyperplasia
• this leads to oedema, ischaemic necrosis and perforation

Question 3

epidemiology of appendicitis?

Answer 3

• the most common surgical emergency (6% lifetime incidence)
• can occur at any age
• most common between 10-20

Question 4

presenting complaints of appendicitis?

Answer 4

• Periumbilical pain that moves to the right iliac fossa
• anorexia
• vomiting
• constipation
• diarrhoea

Question 5

what is mcburneys point?

Answer 5

• this is the point of pain for appendicitis

- (1/3 of the distance from the ASIS to the umbilicus)

Question 6

what are the general signs of appendicitis on physical examination?

Answer 6

• tachycardia
• fever
• furred tongue
• lying still
• shallow breaths

Question 7

what are the signs of the right iliac fossa?

Answer 7

• guarding
• rebound and percussion tenderness
• pain on the right during a PR examination

Question 8

what are specific signs seen with appendicitis?

Answer 8

Rovsing’s Sign - palpation of the LIF causing more pain in the RIF than the LIF
Psoas Sign - pain on extension of the hip
Cope Sign - pain on flexion and rotation of the hip

Question 9

some potential unusual presentions of appendicitis?

Answer 9

• flank pain or RUQ pain
• child might have vague pain but complete anorexia
• confused elderly person with no pain
• sometimes occurs in pregnancy (this is dangerous)

Question 10

investigations for appendicitis?

Answer 10

- bloods 
these will show high WCC, high CRP
- pregnancy test 
for potential ectopic 
- USS 
- CT is unnecessary delay

Question 11

the management plan for appendicitis?

Answer 11

• prompt appendicectomy
• antibiotics
  piperacillin/tazobactam
• laparoscopy is preferred in women and the obese due to diagnostic and therapeutic advantages

Question 12

possible complications of appendicitis?

Answer 12

• perforation
• appendix mass
  when the inflamed appendix becomes covered with omentum
• Appendix abscess
  occurs if the appendix mass fails to resolve

mass and abscess can be treated with drainage and antibiotics

Question 13

what is the prognosis for patients with appendicitis?

Answer 13

uncomplicated - most people recover with no long term problems

ruptured appendix - greater risk of complications and death