Appendicitis

Question 1

Appendix

Answer 1

Small, thin tube arising from caecum

Located at the point where the three teniae coli meet

Single opening to the appendix connects it to the bowel

Question 2

Pathophysiology

Answer 2

Pathogens can get trapped due to obstruction at point where appendix meets bowel

Inflammation may lead to gangrene and rupture

When appendix ruptures, faecal contents and infective material released leads to peritonitis

Question 3

Abdominal pain

Answer 3

Peri-ublical pain radiated as visceral stretching of appendix lumen and appendix is midgut structure

Radiates to RIF as localised parietal peritoneal inflammation

Question 4

Other features

Answer 4

Loss of appetite

Nausea and some vomiting

Low grade fever

Rovsig’s sign

Guarding

Rebound tenderness in RIF

Percussion tenderness

Question 5

Rovsig’s sign

Answer 5

Palpation in LIF causes pain in RIF

Question 6

Diagnosis

Answer 6

Based on clinical presentation and raised inflammatory markers

Urinalysis to exclude pregnancy, renal colic and UTI

US useful in females where pelvic organ pathology suspected

Question 7

Key differentials

Answer 7

Ectopic pregnancy

Ovarian cysts

Meckel’s diverticulum

Mesenteric adenitis

Question 8

Appendix mass

Answer 8

Occurs when omentum surrounds and sticks to inflamed appendix

Forms mass in RIF

Typically managed conservatively with supportive treatment and antibiotics

Appendicectomy once acute condition has resolved

Question 9

Management

Answer 9

Prophylactic IV antibiotics reduce wound infection rates

Appendicectomy

Laparoscopic has fewer risks and faster recovery

Question 10

Complications of appendicectomy

Answer 10

Bleeding, infection, pain, scars

Damage to bowel, bladder and other organs

Removal of normal appendix

Anaesthetic risks

VTE