Acute appendicitis Flashcards
Descibe appendicitis?
- Inflammation of the appendix
- Caused by direct luminal obstruction
- Can also be because of lymphoid hyperplasia, impact stool or caecal/appendix tumour
What are the main risk factors for appendicitis?
- Family history
- Ethnicity
- More common in Caucausians
- Ethnic minorities more at risk of perforation if they develop it
- Environmental
- Seasonal presentation during summer
Describe the clinical features of acute appendicitis?
- Abdominal pain
- Peri-umbilical then migrates to right iliac fossa
- N/V, anorexia, diarrhoea, constipation
- Rebound tenderness and percussion pain over McBurney’s point
What are the textbook signs on examination of someone with acute appendicitis?
- Rovsing’s sign
- Worse RIF pain on palpation of the LIF
- Psoas sign
- RIF pain with passive extension of the patient’s right hip
- Indicates that appendix is retrocaecal in orientation
Differentials for acute appendicitis?
- Young women: exclude ectopic pregnancy or ovarian cyst rupture
- Ureteric stones, UTI
- Diverticulitis, IBD, Meckel’s diverticulum
- Testicular torsion
- Pelvic inflammatory disease
What investigations should be performed for someone with a suspected appenicitis?
- Clinical diagnosis
- Urinalysis
- Serum beta-hcG
- Abdominal US
- Swollen, non-compressible appendix, free fluid in right iliac fossa
- CT scan
Describe the management of acute appendicitis?
- Laparoscopic appendicectomy (gold standard)
- Appendix sent for histopathology
- An open approach can be used in pregnancy
- Prophylactic antibiotics improve clinical outcomes
What are the complications of appendicits?
- Perforation
- Surgical site infection
- Appendix mass where omentum and small bowel adhere to the appendix
- Conservative management with anitbiotics
- Pelvic abscess
Describe a pelvic mass as a complication of appendicitis?
- Presents with fever and a palpable RIF mass
- US or CT for confirmation
- Management with anitbiotics and percutaneous dranage of abscess
- Follow up CT after conservation treatment is recommended
Describe the pain of appendicitis?
- Dull, poorly localised, peri-umbilical pain
- => Sharp, well-localised, RIF pain
- The pain migrates when the parietal peritoneum becomes irritated
- Due to a more defined distribution of nerve supply
Psoas sign is assoicated with which position of the appendix?
Retrocaecal
- Which of the following statements is NOT true about pre-operative evaluation and management of appendicitis patients?
- Antibiotics should cover gram-negative and anaerobic bacteria
- Pre-operative antibiotics are indicated in all patients
- If appendicitis is not perforated, there is no need for pre-operative antibiotics
- If appendicitis is diagnosed by physical exam, there is no need for diagnostic imaging
IF appendicitis is not perforated, there is no need for pre-operative antibiotics
Major cause of appendicitis in younger people?
Hyperplasia of lymphoid follicles
Major cause of appendicitis in older people?
Faecal impaction
In appendicitis where can the most severe pain be elicited?
- Pressing on McBurney’s point
- 1/3 of the line from the ASIS to the umbilicus
