Appendicitis

Question 1

Define appendicitis

Answer 1

Acute appendicitis is an acute inflammation of the vermiform appendix, most likely due to obstruction of the lumen of the appendix (by faecolith, normal stool, infective agents, or lymphoid hyperplasia)

Question 2

Epidemiology?

Answer 2

The MOST COMMON surgical emergency

Can occur at any age

Most commonly occurs between 10-20 yrs

Question 3

Presenting symptoms?

Answer 3

Periumbilical pain that moves to the right iliac fossa

Anorexia is an important feature

Vomiting (may occur after pain)

Constipation

Diarrhoea

Question 4

general signs on examination?

Answer 4

Tachycardia 
Fever  
Furred tongue  
Lying still  
Coughing hurts  
Fetor with/without flushing  
Shallow breaths  
Reduced bowel sounds

RIF Signs;
Guarding
Rebound and percussion tenderness

Question 5

Named signs of appendicitis?

Answer 5

Rovsing’s Sign - palpation of the left iliac fossa causes more pain in the right iliac fossa than the left - poor sensitivity

Psoas Sign - pain in RIF on extending the hip (caused by retrocaecal appendix)

Obturator Sign - pain on flexion and internal rotation of the hip (occurs if the appendix is in close proximity to the obturator internus)

Question 6

Investigations for appendicitis?

Answer 6

Bloods;
High WCC (mainly neutrophils)
High CRP
Ultrasound may help

Abdo-Pelvic CT - high diagnostic accuracy ; abnormal appendix (diameter >6 mm) identified or calcified appendicolith seen in association with peri-appendiceal inflammation

pregnancy test - exclude ectopic pregnancy

Question 7

Management for appendicitis?

Answer 7

Uncomplicated;

1. Supportive: NBM, Fluids, IV Morphine 5mg/Paracetamol
   1b. appendicectomy

ABX: if unfit/declines surgery

• Ceftriaxone IV AND Metronidazole IV
• or cefoxitin

Complicated i.e. perforation, v unwell, shock

1. Supportive - involve critical care
   1b. Emergency appendectomy
   1c. Post-op abx

Question 8

Which condition can often be confused for appendicitis?

Presenting symptoms?
What is the difference?

Answer 8

(Mesenteric) Adenitis

Mesenteric adenitis is an inflammation of the mesenteric lymph nodes in the abdomen.

Adenitis can occur in diff parts of the body.

symptoms;
RIF pain
fever
nausea and vomiting
diarrhea

difference ; adenitis is self limiting. goes away on own without Abx