Appendicitis Flashcards
Pathophysiology?
- Acute inflammation of the appendix
- Obstruction of lumen to appendix by faecolith
- Gut bacteria invade appendix causing inflammation
Complication your most worried about?
If ruptures –> peritonitis
Classic pain?
Peri-umbilical pain that moves to the RIGHT ILIAC FOSSA (McBurneys point)
Other symptoms?
(1) N&V - usually 1/2 times
(2) Anorexia (very common)
(3) Constipation (common) or diarrhoea (rarer)
(4) Systemic - low grade fever
What to consider if patient has vomiting persistently?
Bowel obstruction (mesenteric adenitis)
Signs on examination?
(1) Rovsing’s sign - pain at RIF when palpate LIF
(2) Rebound tenderness + guarding in RIF
Signs of peritonitis?
- High grade pyrexia + tachycardia
- Rigid abdomen
How does the presentation differ in pregnancy?
Pain may be higher up in second trimester
How might young children present?
Infants - watery diarrhoea + vomiting
Young children - vague abdo pain + anorexia
How might an elderly patient present?
Confused, shock, rapid progression
Initial investigations to exclude?
(1) Pregnancy test (urine hCG)
2) Urinalysis (calculi?
Other bedside investigations?
(1) VBG - lactate
(2) urine dipstick - leukocytosis
Bloods?
- FBC - raised WCC (mild leukocytosis)
- raised CRP
Diagnosis based on what?
Clinical diagnosis - imaging only performed if doubt, theatre should not be delayed
Imaging?
CXR - perforation?
CT AP or USS RIF
