Appendicitis Flashcards
def
acute inflammation & infection of the appendix
aetiology
initiated by luminal obstruction by: 1 faecolith (a hard mass of faeces in the intestinal tract which can block the appendix 2 lymphoid hyperplasia 3 oedema 4 helminths 5 caecal carcinoma
epi
very common emergency surgical diagnoses
7% lifetime risk in UK
history
classic presentation
-initially diffuse abdominal pain, periumbilical & colicky
-pain becomes sharp & localised to RIF
-anorexia & nausea are common
alternative presentations
-pain in right flank (retrocaecal appendix)
-pain in RUQ (long appendix)
-pain in lower abdomen (pelvic appendix)
-urinary frequency/loose stools due to bladder/bowel irritation by inflamed appendix
examination
- pyrexia
- facial flush
- tachycardia
- abdominal pain at McBurney’s point, rebound tenderness, guarding
- Rosving’s sign
what is McBurney’s point
2/3 along a line from umbilic to RASIS
what is Rosving’s sign
pain in RIF elicited by applying pressure to LIF
pathogenesis
luminal obstruction causes proliferation of bowel flora & inflammation
swelling causes obstruction & thrombosis of arteries therefore the appendix becomes gangrenous & necrotic
investigations
a clinical diagnosis 1 bloods -high WCC & CRP -LFTs -amylase (to exclude pancreatitis) 2 urine -microscopy, culture & sensitivity -pregnancy 3 imaging -USS difficult to visualise appendix -CT has good sensitivity & specificity 4 diagnostic laparoscopy -for accurate diagnosis & treatment
management
general
-IV fluids
-broad-spectrum antibiotics (with signs of sepsis)
surgery
-appendicectomy
post-op
-antibiotics (especially for gangrenous/perforated appendix)
appendiceal abscess
-drainage either percutaneously (through the skin) or intraoperatively
-may treat with antibiotics, parenteral fluids
complications
inflammatory mass
appendix abscess
perforation & peritonitis
POST-OP
infection
abscess
ileus
prognosis
appendicectomy is curative
if appendicitis left untreated it can be life-threatening
what are the most common bacteria in the appendix
bacteriodes fragilis
e. coli
what is the alvarodo (MANTRELS) score
score used to indicate likelihood of appendicitis Migration of pain to RLQ 1 Anorexia 1 N+V 1 Tenderness in RLQ 2 Rebound tenderness 1 Elevated temp 1 Leukocytosis 1 Shift of WBC to left 1 (high number of young WBC)
how is uncomplicated appendicitis treated
appendicectomy and cefoxitin
