Appendicitis Flashcards Preview

Gastrointestinal Conditions > Appendicitis > Flashcards

Flashcards in Appendicitis Deck (17):
1

What is appendicitis:

Sudden inflammation of the appendix, usually initiated by obstruction of the lumen

2

Epidemiology of acute pancreatitis:

Lifetime incidence 10%

Most common cause of acute abdomen in UK

M>F

Most common between 10-20 years

3

Sex preponderance of appendicitis

M>F

4

Pathophysiology of appendicitis:

GIT flora invade the appendix after lumen obstruction

Leading to oedema, necrosis and perforation

5

Aetiology of appendicitis:

* Lymphoid hyperplasia (secondary to IBD/infection)

* Faecolith

* Parasits (Esp. in East)

* Foreign bodies (rare)

* Neoplasia (rare)

6

Symptoms of appendicitis:

* Early periumbilical pain
* Migration to RIF
* Aggravated by moving/coughing
* Anorexia
* Vomiting
* Constipation
* Diarrhoea (more rarely)

7

Signs of pancreatitis:

Tachycardia
Pyrexia
Localised peritonism RIF
Tenderness
Guarding
Rebound tenderness
RIF percussion tenderness

8

Sign of low lying pelvic appendix:

Pain on R in PR exam

9

Rovsing's sign of appendicitis:

Palpation of LIF causes more pain in R than L

10

Sign of retrocaecal appendix:

Psoas sign

Pain on extending hip

11

Cope sign of appendicitis:

Pain on flexion and internal rotation of R hip

If appendix close to obturator internus

12

Atypical presentations of appendicitis:

1. Elderly: Shock, confusion, no pain

2. Child: Vague abdo pain, anorexia

3. Retrocaecal/retroperitoneal appendix: 25%. Flank/RUQ pain. Only sign may be tenderness on R during PR

4. Pregnancy: Pain less localised and less obvious signs of peritonism. Mortality higher

13

Differential diagnosis of appendicitis:

* Ectopic pregnancy
* UTI
* Mesenteric adenitis
* Cholecystitis
* Diverticulitis
* Salpingitis/PID
* Dysmenorrhoea
* CD
* Perforated ulcer
* Food poisoning
* Meckel's diverticulum

14

Investigations in appendicitis:

1. Bloods: FBC (neutrophilic leucocytosis), CRP

2. Imaging: USS, CT

3. Urine (dipstick ?UTI, pregnancy test ?ectopic)

15

Management of appendicitis:

Prompt appendicectomy

Lap incresingly used

Open surgery for gangrenous perforation

Pharmacological

* Tazocin (1h pre-op)
* Fluids
* Opiate analgesia

16

Complications:

* Perforation
* Wound infection
* Appendix mass
* Abscess

17

Poor prognostic factors in appendicitis:

Pregnancy (esp 20+ weeks)

Elderly