Appendicitis

Question 1

What is Appendicitis?

Answer 1

Gut organisms invade the appendix wall following lumen obstruction

Question 2

What causes luminal obstruction? (3)

Answer 2

Lymphoid hyperplasia, faecolith or filarial worms

Question 3

What happens to the appendix? (4)

Answer 3

Oedema, ischaemia, necrosis and perforation

Question 4

But why does it happen?

Answer 4

May have inability to prevent invasion e.g immunosuppression, or they are not tolerant to pathogens (Hygiene Hypothesis)

Question 5

Is it common?

Answer 5

The most common acute surgical procedure

Question 6

Who does it affect?

Answer 6

People aged between 10 and 20 years old

Question 7

Symptoms (3)

Answer 7

Fever, periumbilical pain that moves to the right iliac fossa, constipation

Question 8

Signs (5)

Answer 8

Rebounding and percussion tenderness, Rousing’s Sign (Pain in RIF>LIF), Tachycardia, flushing, Shallow breathing

Question 9

What bloods would you do?

Answer 9

FBC (shows neutrophil leucocytosis), CRP

Question 10

Other Investigations? (2)

Answer 10

Ultrasound, CT

Question 11

Differentials (3)

Answer 11

Ectopic pregnancy, UTI, Anything causing peritonitis

Question 12

First line treatment

Answer 12

Prompt appendicectomy

Question 13

Other Treatment (3)

Answer 13

Antibiotics-usually Metronidazole and Cefuroxime, Analgesia, fluids

Question 14

Complications (3)

Answer 14

Perforation, Appendix Mass (attached to omentum), Abscess