Acute appendicitis

Question 1

Appendicitis population

Answer 1

Lifetime risk males 12.5% women 25%
Most common 10 to 19
Most common non obstetrical surg in pregnancies

Question 2

Causes of appendicitis

Answer 2

Obstruction of vermiform appendix, typically by a fecalith. Less frequently lymphatic tissue, gallstone, tumor, parasites

Question 3

Atypical pain of appendicitis

Answer 3

Right flank or pelvic, LUQ RUQ in pregnancy

Question 4

Clinical features of appendicits

Answer 4

Early - general malaise, indigestion, bowel irregularity, anorexia
Diarrhea, constipation, complete obstruction.
Subjective or objective fever
N/V, periumbilical pain
Further on - RLQ pain, dysuria, hematuria
Ruptured sometimes immediately relieves pain

Question 5

Alvarado score

Answer 5

1 point for each of migration, anorexia, urinary acetone, rebound, fever
2 points for elevated WBC, and RLQ tenderness
1-4 low risk
possible or probably 5-9

Question 6

Special populations

Answer 6

Old, retarded etc tend to present later with more diffuse symptoms
Pregnancies, serious. Could also be ovarian torsion and ectopic or heterotopic