(!) Acute Appendicitis Flashcards
Define Acute appendicitis
Infection of the veriform appendix (at caecum), often due to obstruction from stool, infective agents, lymphoid hyperplasia)
Aetiology and risk factors of Acute appendicitis
Obstruction in the appendix (stools, infective agents, other) causes the appendix to fill with mucus-distort the appendix and allow bacteria to rapidly multiply
Main causing organism-E.coli and Bacteroides Fragilis
The distention of the lumen of the appendix is what causes most initial Sx
After a while, perforation occurs
Risk factors age 19-59 Men Low Fibre diet Smoking increase of hygiene in modern society
Epidiemology of Acute appendicitis
One of the most common cause of acute surgery
And nearly always an emergency
34000 a year in UK (common)
Signs and Sx of Acute appendicitis
Classical signs:
Initial umbilical pain that moves toward the RLQ over 12h
Constant pain with intermittent cramps
Worse with movement or straining
Retrocaecal can cause flank pain. Retroillial-testicular, pelvic appendix-suprapubic
Anorexia/appetite loss-always there N&V RLQ tenderness AIR criteria-help diagnose appendicitis Mild fever (rarely high)
Perforated-rigid abdomen (peritonitis), Guarding , Shock, reduced bowel sounds
Investigations of Acute appendicitis
Mainly clinical diagnosis-emergency
FBC-MILD leukocytosis
CRP-high
ABdo USS-non compressible and over 6mm
CT scan-over 6mm appendix or calcified
Do pregnancy test, Urine Dip and G+S
Management of Acute appendicitis
SUPPORTIVE treatment-analgesia, fluids
if Fit for surgery-Nil by mouth, then-appendectomy
Unfit/doesnt want-abx
Perforated-surgery then Abx
Complications of Acute appendicitis
Perforation-> peritonitis
Shock->death
Appendicular abscesses-as disease progress. CT should show
surgery complications (intra abdomen abscesses, infection)
Prognosis of Acute appendicitis
Great prognosis if diagnosed early-and treated
surgery is better than Abx
but laparoscopic surgery is better than normal surgery
