Appendicitis Flashcards
(13 cards)
In what patients does appendicitis commonly present?
Young patients aged 10-20 years old
What are some important differentials for appendicitis?
Ectopic pregnancy, ovarian cyst with torsion / rupture, Meckel’s diverticulitis, Mesenteric adenitis
What is mesenteric adentitis?
Inflammation of the abdominal lymph nodes
Children with abdominal pain following tonsilitis or URTI
What is Meckel’s diverticulum?
Malformation of distal ileum, which is asymptomatic and requires no treatment
What are the clinical features of appendicitis?
Mild fever, peri-umbilical pain with radiation / migration to RIF. Some episodes of vomiting, anorexia, mild fever
What are some investigations to help diagnose appendicitis?
Mostly clinical - history + bloods
Urine dip - positive for leukocytes, -ve for nitrites
Pregnancy test in all childbearing age females
VBG - raised lactate
FBC - neutrophilia
CRP - raised
clotting, G&S for theatre
LFTs and amylase to rule out other conditions
blood cultures if septic
Imaging - ONLY DO IF IN DOUBT/RULE OUT
Erect CXR to rule out perforation
Ultrasound - may see free fluid, CT to exclude other causes
What is the management of appendicitis?
Prophylactic ABX, followed by laparoscopic appendicectomy
If uncomplicated appendicitis, i.e not septic -> IV fluids and antibiotics
What may be seen on examination in appendicitis?
Rovsing sign positive, on DRE boggy sensation for pelvic abscess, tenderness at McBurney’s point, rebound tenderness/percussion tenderness if associated peritonitis, Psoas sign, Obturator sign
Which part of the spinal cord does the visceral pain in appendicitis originate ?
T8 - T10
What is McBurney’s point?
1/3 of the way from ASIS to umbilicus
What is the psoas sign?
Pain on passive extension on right thigh
What is the obturator sign?
Pain with passive internal rotation of right hip
What are complications of appenidicitis?
Gangrene
Local abscess
Perforation -> septicaemia
Peritonitis
