Appendicitis Flashcards

1
Q

Define appendicitis

A

Acute inflammation of the vermiform appendix

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2
Q

What is the aetiology of appendicitis

A

Obstruction of the lumen of the appendix is the main cause of acute appendicitis
Faecolith (hard mass of faecal matter), normal stool, or lymphoid hyperplasia are the main causes

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3
Q

What are the risk factors for appendicitis

A

Teenage
Low dietary fibre
Improved personal hygiene
Smoking

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4
Q

What is the epidemiology of appendicitis

A

Most common cause of abdominal pain in childhood requiring emergency abdominal surgery
Peak incidence in teens
Rare <3yo

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5
Q

What are the symptoms of appendicits

A

May present as a child complaining of general tummy pain, withdrawn and will not move posture

Anorexia
Nausea and vomiting
Abdominal pain
- Umbilical region to RIF (1-12hrs later)
- Acute onset
- Constant with intermittent cramps (colicky pain)
- Worse on movement and coughing
Fever
Loose stool (low volume, not usually offensive) OR Constipation
Collapse and generalised peritonitis (Due to rapid physiological deterioration in this age group from a narrow appendiceal lumen)

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6
Q

What do the sites of pain in appendicitis indicate

A

Flank or back: retrocaecal appendix
Testicular pain: retroileal/pre-ileal appendix
Suprapubic pain: pelvic appendix

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7
Q

What are the differentials for appendicitis

A

Ovarian torsion
Ectopic pregnancy
Mesenteric adenitis
Colic
Intussusception
Meckel’s diverticulitis
Mittelschmerz
PID

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8
Q

What are the signs of appendicitis on examination

A

General and obs
- Hypotension and tachycardia
- Low-grade pyrexia
- Flushed face and a fetor
- Patient staying still -> peritonitis (due to rupture)

Abdominal
- Tense, rigid abdomen
- Right lower quadrant tenderness, rebound tenderness
- Palpable mass
- Reduced bowel sounds
- Rovsing’s sign: Pain in the RIF when the LIF is palpated
- Cope’s sign: Pain on passive flexion and internal rotation of the hip
- Psoas sign: Pain on extending the hip (patient lies on side)*

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9
Q

What investigations should be done for appendicits

A

Bedside: urinalysis and dipstick, pregnancy test (childbearing age)

Blood: FBC(↑WCC), CRP (↑), G&S, U&Es

Other:
- US abdomen (Aperistaltic or non-compressible structure with outer diameter >6 mm)
- AXR (faecolith)
- CT abdomen (Abnormal appendix, diameter >6mm, or calcified appendix. Appendicolith seen in association with peri-appendiceal inflammation)

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10
Q

What is the management for uncomplicated appendicitis

A
  1. A-E assessment
  2. Call the surgical on-call team
  3. supportive treatment (AGAME)
    - Analgesia e.g. paracetamol, diclofenac, morphine
    - G&S
    - Antibiotics (see below)
    - MRSA screen
    - Eating and drinking - make NBM + NG feeds

No signs of sepsis → IV Abx co-amoxiclav

Signs of sepsis → laparoscopic appendicectomy ± post-op Abx (amoxicillin + metronidazole)

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11
Q

What are the complications of appendicitis

A

Perforation (more common with faecolith i.e. in children)
Generalised peritonitis
Appendicular mass
Appendicular abscess

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12
Q

What is the prognosis for appendicitis

A

If treated, prognosis is good
Wound infection and intra-abdominal abscess are potential complications associated with appendicectomy
Laparopscopic appendicectomy has been shown to decrease the incidence of overall complications

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13
Q

Which factors predict perforated appendix

A

Under 9yo
Abdominal pain >48 hours
Temp. >37.9
Signs of peritoneal irritation

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