Appendicitis

Question 1

What is appendicitis?

Answer 1

Inflammation of the appendix, usually due to obstruction, leading to infection and possible perforation

Question 2

What are the classic symptoms of acute appendicitis?

Answer 2

Periumbilical pain migrating to right lower quadrant, anorexia, nausea, vomiting, and fever

Question 3

What are important signs to look for on examination in suspected appendicitis?

Answer 3

Right iliac fossa tenderness, rebound tenderness, guarding, and possible low-grade fever

Question 4

What imaging is first-line in suspected appendicitis?

Answer 4

Ultrasound abdo / pelvis

Question 5

what is the gold standard imaging in diagnosing appendicitis?

Answer 5

contrast CT abdo/pelvis

Question 6

What are complications of untreated or delayed appendicitis?

Answer 6

Perforation, abscess, peritonitis, and sepsis

Question 7

What is the management if an appendix mass or abscess is found?

Answer 7

Percutaneous drainage and antibiotics may be considered, with delayed surgery if needed

Question 8

Where is the McBurney’s point?

Answer 8

1/3 of the distance from the anterior superior iliac spine (ASIS) to the umbilicus, in the right lower quadrant

Question 9

Clinical relevance of the McBurney’s point

Answer 9

Tenderness at this point, and Rebound tenderness = appendicitis

Question 10

What is Rovsing’s sign?

Answer 10

Palpation of the left lower quadrant causes pain in the right lower quadrant, due to peritoneal irritation

Question 11

What is the psoas sign?

Answer 11

Pain on extension of the right hip, indicating irritation of the psoas muscle by an inflamed retrocaecal appendix

Question 12

What is the obturator sign?

Answer 12

Pain on internal rotation of the flexed right hip, suggesting a pelvic appendix irritating the obturator internus muscle

Question 13

What is the significance of a palpable mass in the right lower quadrant?

Answer 13

May indicate an appendiceal mass or abscess formation in complicated appendicitis

Question 15

Classic Appendicitis Sx sequence: essential for exam

Answer 15

Anorexia (loss of appetite), then pain, then vomit

Question 16

Appediceal abscess Sx

Answer 16

1. Develops RIF pain and fever for 1-2 days then resolves, then recurs 7-10 days later
2. Palpable mass on RIF

Question 17

Appendicitis Mx

Answer 17

• Open Appendectomy: McBurney (oblique) or Rocky-Davis (transverse) right lower quadrant muscle-splitting incision
• Laparoscopic appendectomy

Question 18

What is the role of antibiotics in appendicitis management?

Answer 18

IV antibiotics should be given pre-operatively and post-operatively

Question 19

Most common post appendectomy complications

Answer 19

• Surgical Site Infection
• Intra-abdominal or Pelvic Abscess