APPENDICITIS

Question 1

what is appendicitis

Answer 1

inflammation of vermiform appendix

most likely due to obstruction of appendix lumen

Question 2

What are key diagnostic factors

Answer 2

peri-umbilical pain migrating to right iliac fossa

anorexia
nausea and vomiting
right lower quadrant tenderness

Question 3

What are other diagnostic factors

Answer 3

age- common in younger people
low grade pyrexia
flushed face and fetor
reduced bowel sounds

Question 4

What are risk factors of appendicitis

Answer 4

low dietary fibre
smoking

Question 5

What can be expected to be seen on examination of someone with appendicitis?

Answer 5

generalised peritonitis if perforated
- rebound and percussion tenderness,guarding and rigidity

• ROVSINGS sign - palpation in LIF causes pain in RIF

-Psoas sign - pain on extension of hip

Question 6

What are the first line of investigations

Answer 6

FBC
CRP
Abdomincal US
Contrast CT if abdominal US is inconclusive

Question 7

What are other investigations should be considered

Answer 7

urinalysis - exclude UTI
pregnancy test
abdominal MRI if US inconclusive in pregnant women

Question 8

What is management of appendicitis

Answer 8

1st line - laparoscopic appendicetomy

if perforated , emergency with abdominal lavage

if mass present - IR drainage , conservative management with Abx then elective interval appendicetomy

If unfit/unwilling, supportive treatment with analgesia and Abx