Acute Appendicitis

Question 1

What is appendicitis?

Answer 1

Inflammation of the vermiform appendix which results in oedema, ischemeic necrosis and perforation, if left untreated

Question 2

Epidemiology

Answer 2

Most common surgical emergency
Rare in those <2
Peak 10-22
Inc: 6%

Question 3

Main cause of acute epidode

Answer 3

Obstruction of the lumen of the appendix

-faecolith most common

Question 4

Pathophysiology

Answer 4

Gut organisms colonise appendix wall
Distal lumen fills with mucus = dilation
Lumen pressure > vascular pressure = engorgement
RUQ pain
Small arteries become thrombosed = ischemia then perf

Question 5

Presentation of acute app.

Answer 5

Periumblical pain over McBurneys
Anorexia
Nausea
Constipation/Diarrhoea
Rebound and Percussion tenderness
Pain on movement

Question 6

RFs for acute app

Answer 6

Smoking
Low fibre
<6 month breastfeeding

Question 7

Special signs to illicit in ?acute app

Answer 7

Rosvings: pain in RIF > LIF when LIF is pressed
Psoas: pain on extending hip indicates retrocaecal appendix
Cope: pain on flexion and internal rotation of R hip

Question 8

Ix to consider in acute app

Answer 8

bloods: fbc - leucocytosis
CRP elevated
abdo and pelvic CT if dx unclear

Question 9

Mx of acute app

Answer 9

Dx certain = appendictomy
Dx uncertain = observe
Abx: met + cef 1 hr pre-op
Analgesia: mild opiate