Appendicitis Flashcards
How common is it?
Annual incidence is 10 cases per 100,000 population (US)
Who does it affect?
he incidence of appendicitis gradually rises from birth, peaks in the late teen years, and gradually declines in the geriatric years.
What causes it?
Obstruction of the appendiceal lumen by:
- lymphoid hyperplasia secondary to IBD
- infections (more common during childhood and in young adults)
- fecal stasis and fecaliths (more common in elderly patients)
- parasites (especially in Eastern countries)
- more rarely, foreign bodies and neoplasms.
How does it present? What symptoms should you look out for?
Presentation inconsistent due to varying positions of the appendix
Classic history:
- anorexia
- periumbilical pain followed by nausea, right lower quadrant (RLQ) pain
- vomiting
- occurs in only 50% cases
What signs may the patient have on examination?
- rebound tenderness
- pain on percussion
- rigidity
- guarding
Also:
- tenderness at McBurney’s point
- RLQ tenderness
Which other conditions might present similarly?
Abdominal Abscess Bacterial Gastroenteritis Cholecystitis and Biliary Colic Constipation Crohn Disease Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females Diverticulitis Ectopic Pregnancy Endometriosis Gastroenteritis Inflammatory Bowel Disease Intussusception Mesenteric Ischemia Imaging Mesenteric Lymphadenitis Nephrolithiasis Omental Torsion Ovarian Cysts Ovarian Torsion Paediatric Meckel Diverticulum Pelvic Inflammatory Disease Urinary Tract Infection (UTI) in Males
How would you investigate this patient?
FBC
U&Es
CXR
USS
What would you tell the patient and how would you explain the condition to them?
Appendicitis is a painful swelling of the appendix. The appendix is a small, thin pouch about 5-10cm (2-4 inches) long. It’s connected to the large intestine, where stools (faeces) are formed.
Nobody knows exactly why we have an appendix, but removing it isn’t harmful.
How do you think the patient and/or family might be affected by the diagnosis? Will it affect their
ability to work/care for themselves?
The may be very acutely unwell, but if caught quickly they should make a full recovery.
What questions are they likely to have?
How long will it take me to get better?
What treatment/s (surgical, pharmacological and non-pharmacological) would you discuss with
them? What risks and benefits of treatment are there?
Appendectomy
Sometimes Abx
Analgesia
Supportive therapy if required
