Appendicitis Flashcards
what is the definition of an appendicitis?
Acute appendicitis is an acute inflammation of the vermiform appendix, most likely due to obstruction of the lumen of the appendix
what is the epidemiology of appendicitis?
Most common cause of acute abdo pain admitting to A&E
Lifetime risk = 8.6% males, 6,7% female
Common between 10 and 30 years
what is the aetiology of appendicitis?
Obstruction of the lumen of the appendix is the main cause of acute appendicitis. Faecolith (a hard mass of faecal matter), normal stool, or lymphoid hyperplasia are the main causes for obstruction
what are the risk factors for appendicitis?
Low dietary fibre
Improved personal hygiene - western societies
Smoking
what is the pathophysiology of an appendicitis?
The lumen distal to the obstruction starts to fill with mucus and acts as a closed-loop obstruction. This leads to distension and an increase in intraluminal and intramural pressure. As the condition progresses, the resident bacteria in the appendix rapidly multiply.
what are the key presentations of appendicitis?
Abdominal pain Anorexia Nausea and vomiting RLQ tenderness High or immediate risk score
what are the signs of an appendicitis?
Anorexia High or immediate risk score Palpable mass Reduced bowel sounds Psoas sign Hypotension or tachycardia
what are the symptoms of an appendicitis?
Abdo pain
Nausea
Tense or rigid abdo
Flushed face
what are the first line and gold standard investigations for an appendicitis?
physical examination
FBC - leukocytosis (10-18 x 109/L or 10,000 to 18,000/microlitre in adults; ≥16 x 109/L or 16,000/microlitre in children)
CRP
Abdo ultrasound - aperistaltic or non-compressible structure with outer diameter >6 mm
Contrast enhanced abdominal CT
what are the differential diagnoses for appendicitis?
Acute mesenteric adenitis, viral gastroenteritis, Meckel’s diverticulitis
how is appendicitis managed?
Supportive treatment
Appendectomy / antibiotics (not fit for surgery)
how is appendicitis monitored?
Patients are usually discharged from hospital 1 day after the operation for uncomplicated appendicitis. Complicated appendicitis may require a longer hospital stay depending on the response to treatment.
what are the complications of an appendicitis?
Perforation Generalised peritonitis Appendicular mass Appendicular abscess Surgical wound infection
what is the prognosis of an appendicitis?
If patients are treated in a timely fashion, the prognosis is good. Wound infection and intra-abdominal abscess are potential complications associated with appendectomy
