GI - Appendicitis

Question 1

define appendicitis

Answer 1

inflammation of the appendix and is a common acute surgical presentation

Question 2

pathophysiology of appendicitis

Answer 2

1. luminal obstruction - due to faecolith, lymphoid hyerplasia, malignancy
2. invasion by commensal bacteria
3. acute inflammation
4. increased pressure –> ischaemia –> necrosis –> perforation

Question 3

rf for appendicitis

Answer 3

• fhx
• white ethnicity
• summer
• CF

Question 4

sx in kids of appendicitis

Answer 4

• abdominal pain
• Nausea and vomiting
• Loss of appetite
• Fever
• Pain with movement
• diraahoea
• left sided pain soemtimes

Question 5

main causes of appendiciti sin kids

Answer 5

• blockage at opening of appendix
• IBD
• abdominal infection
• digestive tract infection

Question 6

describe the abdmoninal pain appendicitis

Answer 6

dull peri-umbilical pain that is poorly localised (from visceral peritoneum inflammation), but later migrates to the right iliac fossa, becoming localised and sharp

Question 7

complications of appendicitis

Answer 7

ruptured appendix
peritonitis
sepsis

Question 8

what tests are done for appendicitis

Answer 8

1. bloods
2. urinalysis
3. abdominal ultrasound - first line
4. abdominal MRI - second line
5. CT

Question 9

what is found on clinica examination for appendicitis

Answer 9

rebound tenderness and percussion tenderness over McBurney’s point

can progress to guarding, especially if the appendix is perforated

Rovsing’s sign

Psoas sign

Question 10

what is found on clinical exam if pateint has appendiceal mass

Answer 10

a mass in the right lower abdomen may be palpable.

Question 11

how to treat mild appendicitis

Answer 11

antibiotics

Question 12

how to treat severe appendictiis

Answer 12

surgery - laparoscopic appendicectomy GS

Question 13

how to treat an appendiceal mass,

Answer 13

antibiotic therapy is favoured, with an interval appendectomy then performed approximately 6-8 weeks later

Question 14

what is rosvings sign

Answer 14

right iliac fossa pain on palpation of the left iliac fossa

Question 15

what is Psoas sign

Answer 15

right iliac fossa pain with extension of the right hip, suggestive of a retrocaecal appendix abutting the psoas muscle

Question 16

what other systems must u examine in child with acute appendicitis

Answer 16

obvs GI
also cardiorespiratory and urinary systems

Question 17

what score is best for stratifying appedicitis risk in children

Answer 17

Shera score