Appendicitis

Question 1

Acute appendicitis is the most common acute abdominal condition requiring surgery. It can occur at any age but is most common in young people aged 10-20 years.

What are the clinical features of appendicitis?

Answer 1

• peri-umbilical abdominal pain radiating to RIF
• migration of pain from centre to RIF = strong indicator of appendicitis
• pts often report pain being worse on coughing or going over speed bumps
• vomit once or twice
• mild pyrexia (37.5-38)
• anorexia common
• 50% of pts have typical symptoms of anorexia, peri-umbilical pain + nausea followed by more localised right lower quadrant pain

O/E → generalised/local peritonitis, Rosving’s sign

Question 2

How is diagnosis of appendicitis made?

Answer 2

• typically raised inflammatory markers coupled w/ clinical findings
• urine analysis → exclude pregnancy, renal colic, UTI
  
  • may show leucocytosis in appendicitis
• USS → free fluid should raise suspicion
• CT → debated use in UK

Question 3

What is the management of appendicitis?

Answer 3

• appendicectomy → open or laparoscopic (preferable)
• prophylactic IV Abx
• perforated appendicitis → abdominal lavage
• appendix mass without peritonitis → Abx + interval appendicectomy
• be wary of elderly: underlying caecal malignancy or sigmoid diverticular disease
• use of antibiotics alone controversial

Question 4

What is meckel’s diverticulum?

Answer 4

• congenital diverticulum of small intestine
• remnant of omphalomesenteric duct
• contains ectopic ileal, gastric or pancreatic mucosa
• occurs in 2% of population
• is 2 feet from ileocaecal valve
• is 2 inches long

Question 5

What is the presentation of Meckel’s diverticulum?

Answer 5

• usually asymptomatic
• abdominal pain mimicking appendicitis
• rectal bleeding
• intestinal obstruction → secondary to an omphalomesenteric band (most commonly), volvulus + intussusception