Appendicitis (1)

Question 1

What is its pathophysiology?

What are its differentials?

What are its complications?

Answer 1

➊ Lumen obstruction by a faecolith, foreign body, or fibrosis. Bacteria invade the appendiceal wall, getting trapping, therefore allowing for infection and inflammation to occur.

➋ • Ectopic pregnancy
• UTI
• Crohn’s
• Mesenteric Adenitis
• Meckel’s Diverticulum

➌ • Abscess
• Perforation - presents peritonitic, and is a surgical emergency

Question 2

How does it present?

What is found O/E?

Answer 2

➊ • Progressive umbilical pain that localises to the RIF
• N+V
• Fever

➋ • Tenderness at McBurney’s point (1/3 from ASIS to Umbilicus)
• Rovsing’s sign - Palpation in LIF causes pain in RIF
• Guarding, rigidity, and peritonism if perforation

Question 3

Which investigations should be done?

What imaging may be used?

How is it managed?

Answer 3

➊ • Pregnancy test! - rule out ectopic
• Urine dipstick! - rule out UTI
• Bloods - FBC, CRP, VBG (Lactate)
• Imaging - CT best for it, but should be avoided in children due to radiation (USS good alternative)

➋ • Erect CXR - rule out perforation
• CT or USS

➌ • Appendicectomy
• Prophylactic Abx +/- sepsis 6 if appropriate