Appendicitis

Question 1

Outline the pathogenesis of appendicitis

Answer 1

Obstruction of the appendix (faecolith, parasites, lymphoid hyperplasia) causes bacterial build-up and invasion of the appendix wall. Leads to inflammation, oedema, necrosis and perforation, eventually.

Question 2

What are likely findings on history and examination in patients with appendicitis?

Answer 2

• Central abdo pain moving to the RIF
  
  • Peritonism
• Nausea, fever, anorexia
• Rovsing sign - pain in RIF when left side pressed
• Psoas sign - pain in RIF on hip extension (retrocaecal appendix)

Question 3

What are the prinicples of management of appendicitis?

Answer 3

• IVAB (cefoxitin)
• Surgery - open or laparoscopic

Question 4

What is the Alvarado score? How is it determined?

Answer 4

A clinical score used to determine likelihood of appendicitis. M and L are worth two points

• M - migration to RIF
• A - anorexia
• N - nausea/vomiting
• T - tenderness (rebound)
• R - RLQ tenderness
• E - elevated temp (>37.3)
• L - leukocytosis (>10000)
• S - shift (left) of neutrophils

5-6 - possible, 7-8 - probable, 9-10 -very probable