Appendicitis Flashcards
Describe the gross morphology and neurovascular supply of the appendix
Narrow-blind end tube attached to posteromedial aspect of the caecum
Free end can vary in location
Caecum supplied by midgut
SMA –> ileocolic artery –> appendicular artery –>
Appendicular vein –> ileocolic vein –> SMV
SM plexus –> ileocolic branch
What is the lymph drainage of the appendix?
Ileocolic upper and lower lymph
Follow artery
What position is the appendix in if it is described as ___?
a. Pre-ileal
b. Post-ileal
c. Sub-ileal
d. Pelvic
e. Sub-caecal
f. Paracaecal
g. Retrocaecal
a. Ant to terminal ileum – 1pm
b. Posterior to terminal ileum – 2pm
c. Parallel with TI – 3pm
d. Descending over pelvic brim – 5pm
e. Below caecum – 6pm
f. Alongside the lateral border of caecum – 10pm
g. Behind caecum – 11pm
What are the different types of incision and how do they differ?
The incision can be;
McBurney = parallel to EO and 1-2 inches in from ASIS
Lanz = transverse incision in RIF
Pararectus = vertical incision along the lateral border of RA, runs parallel to the rectum
the appendix is then identified, mobilised, ligated and removed
What layers do you cut through to get to the appendix?
Skin Superficial (Camper’s) fascia Deep (Scarper’s) fascia External oblique aponeurosis EO muscle Internal Oblique fascia and muscle Transversus oblique fascia and muscle
What are some Classic S&S of appendicitis?
Anorexia N&V Abdominal pain – typically periumbilical/epigastric RIF Whole-body stiff --> lie down with knees to chest to reduce pain Rebound tenderness Pain on percussion Abdominal guarding Worsening pain as time passes
What are some alternative S&S of appendicitis?
LLQ pain –> situs inversus
Inflamed hemiscrotum –> especially in children
RUQ or R flank pain –> if late pregnancy
What signs might help you differentiate that the appendicitis has perforated?
Symptoms last longer than 48hrs
More common in the elderly (late presentation + diagnosis)
Seen in patients with comorbidities e DBM
Often acutely ill
Dehydrated
Electrolyte abnormalities
Localises to RLQ –> whole peritoneum becomes inflamed
What is McBurney’s sign?
Pain at McBurney’s point
= 1/3 of the distance from ASIS to the umbilicus
Even though diagnosis of appendicitis is often purely clinical, what might been seen on imaging?
CT – wall thickening, wall enhancement, inflammatory changes in surrounding tissue
USS – use for pregnant women – hard to visualise appendix and hard to see inflammation
List some DDx of appendicitis
Diverticulitis gastroenteritis intussusception crohn's/UC PID UTI kidney stones
What might show on blood and urine tests if a person has appendicitis?
Blood:
raised polymorphonuclear leukocytes
mild leucocytosis
Urine:
to exclude pregnancy
looking for RBCs, WBCs, or nitrates –> if positive, then maybe renal colic/UTI
glucose/ketones may suggest ketoacidosis
How is appendicitis managed?
fluids, abx, abscess drainage
(maybe CT)
appendectomy - typically laparoscopy as a diagnosis but appendix will be removed regardless
Why are incisions made through IO made along the fibres?
to help healing time
preserve abdominal wall integrity
reduce risk of incisional hernias
