Flashcards in Appendicitis Deck (11):
Different positions of the appendix
Pre-ileal – Anterior to the terminal ileum – 1 o’clock.
Post-ileal – Posterior to the terminal ileum – 2 o’clock.
Sub-ileal – Parallel with the terminal ileum – 3 o’clock.
Pelvic – Descending over the pelvic brim – 5 o’clock.
Sub-caecal – Below the cecum – 6 o’clock.
Paracaecal – Alongside the lateral border of the cecum – 10 o’clock.
Retrocaecal – Behind the cecum – 11 o’clock.
Most common positions of the appendix
Retrocaecal and subileal
Arterial and venous supply of the appendix
Appendicular artery (from Ileocolic artery -> SMA) and appendicular vein
Nerve supply for appendix
Superior mesenteric plexus (ileocolic branch)
Acute inflammation of the appendix
Typical presentation of appendicitis
Acute abdominal pain starting in the mid-abdomen and later localising to the right lower quadrant.
Associated fever, nausea and vomiting, anorexia
Common causes of appendicitis
Young due to increase in lymphoid tissue which occludes the appendix
Faecolith (hard faecal mass)
Most common bacteria in the appendix
Escherichia Coli and Bacteroides Fragilis
Signs for appendicitis
Rovsing's sign- Pressing the left side of the abdominal cavity and eliciting pain in right lower quadrant.
Psoas sign- Extending the right thigh on left lateral position elicits pain in right lower quadrant.
Obturators sign- Pain is elicited at right lower quadrant of abdomen by internal rotation of the flexed right thigh.
Management of appendicitis