Acute Appendicitis Flashcards
What is appendicitis
Inflammation of the appendix
What causes appendicitis
Due to direct luminal obstruction secondary to:
- faecolith
- impacted stool
- Appendiceal tumor
- caecal tumour
What are the risk factors for appendicitis
Family history
Ethnicity - more common in Caucasians but if in ethnic minorities => more risk of rupture
Environmental - seasonal presentation during this summer
What does the patient present with in acute appendicitis
Initial peri-umbilical pain that is dull and poorly localised which later migrates to the RIF where the pain is sharp and well localised.
Other Sx
- vomiting ( due to pain )
- anorexia
- nausea
What are the examination finding you may find on a pt with appendicitis
Tachycardic
Tachypnoeic
Pyrexial
Rebound tenderness
Percussion pain over RIF ( McBurney’s point )
If perf => peritonitis therefore:
- guarding
- RIF mass if there is a abscess
On examination you may also find the rovsings and psoas sign on a pt with appendicitis
What are they
Rovsings - RIF pain when palpating LIF
Psoas sign - RIF pain when right hip extension
What are the differential diagnoses for RIF pain
GI: Meckels diverticulum, diverticulitis, mesenteric adenitis, IBD
Renal: ureteric stones, UTI, pyelonephritis
Urological: testicular torsion, epididymo - orchitis
Gynaecological: ectopic pregnancy, PID
What is the rule of 2s for meckels diverticulum
2% of the population 2% symptomatic 2x more likely in male than females 2 feet proximal to the ileocaecal valve <2years old 2 inches long
What laboratory tests should be ordered to investigate acute appendicitis
Urinalysis
Pregnancy test in females
Routine bloods - FBC, CRP, serum b-hCG
What imaging modalities can you use to investigate acute appendicitis
Should mostly be a clinical diagnosis however the following can be used:
Transabdo USS
CT scan
What is UHLs appendix pathway
If WCC, CRP is raised but USS is negative => have to do a CT scan to confirm diagnosis
This has reduced the amount of lily white appendix that UHL have encountered.
What are the scoring systems available to help stratify the risks of appendicitis
Alvarado
Appendicitis inflammatory Response score
What is the surgical management of acute appendicitis
It’s a surgical emergency and the definitive treatment is laparoscopic appendicectomy
What are the complications of appendicitis
Perforation - can cause peritonitis
Surgical site infection
Appendix mass - small bowel and the omentum adhere to the appendix
Pelvic abscess - presents as swinging fever + palpable RIF mass - needs USS/CT to confirm
How do you treat pelvic abscesses
Abx and drainage
Follow up CT required after conservative treatment in those over 40 due to concurrent malignancy risk
