Appendicitis

Question 1

Appendicitis Epidemiology

Answer 1

• Most common cause of acute abdomen

- 10% of population will develop appendicitis

Question 2

Appendicitis Presentation

Answer 2

• Classic symptoms do not appear in young children, pregnant women and in the elderly
• Pain; periumbilical to RIF, aggravated by movement and coughing
• Nausea, vomiting, anorexia, constipation
• Temperature and pulse initially normal then low grade pyrexia develops
• Rising pulse rate may be indication of peritonitis
• Rovsings sign, psoas test, obturator test
• RIF peritoneum can be demonstrated by rebound tenderness
• Stage of illusion; just after perforation, child may sit up and appear better

Question 3

Appendicitis Atypical Presentation

Answer 3

• Pain may be atypical due to atypical positioning
• Therefore consider appendicitis in all acute abdominal pain
• In pregnancy appendicitis’s pushed upwards, pain may be higher

Question 4

Appendicitis Scoring Systems

Answer 4

Alvarado

Question 5

Appendicitis Differentials

Answer 5

GI
-Obstruction, constipation, intussusception, strangulated hernia, acute cholecystitis , perforated peptic ulcer
Urological
-Torsion, calculi, UTI
Gynae
-Ectopic, cyst, PID
Others
-DKA, pneumonia, porphyria

Question 6

Appendicitis Ix

Answer 6

Clinical diagnosis, the following may be useful

• Urinalysis (exclude UTI)
• Pregnancy test
• Bloods
• USS, CT, laparoscopy

Question 7

Appendicitis Management

Answer 7

• All suspected cases should be admitted
• Appendicectomy
• Spontaneous resolution can occur but appendicectomy is very low risk
• Fluids and analgesia
• Pre-operative antibiotics