Appendicitis

Question 1

Appendicitis most common location

Answer 1

Retrocaecal

Question 2

Appendicitis imagining and their findings

Answer 2

Uss : non compressibility if gallbladder
Dilated appendix >6cm

CT : peri appendiceal fat stranding- sign of inflammation
High sensitive
Normal faecolith detection
Dilatation

Question 3

Appendicitis clinical presentation

Answer 3

Adolescences/young adult
Pain- peri umbilical (visceral)
Pain migrates to RIF
NAUSEA, vomiting, anorexia
Low grade fever
May have diarrhea and urinary symptoms (pelvic appendicitis)

Question 4

RIF in females … differentials, question ask in HX

Answer 4

Ask about LMP
vaginal bleed
Pregnancy test
Discharge( ovarian cysts, PID , ectopic)

Question 5

Appendicitis signs

Answer 5

Lying still 
Fetor oris 
Increase pulse 
Abdominal still in respiration
Tender/ guarding, maximum in Mc Burney’s point
Signs: rovsing, Psoas , obturator
DRE: tender/boggy in RIF 
VE: adnexal mass

Question 6

Appendicitis investigations

Answer 6

None (if classic presentation)
White cell count - sensitive , not specific

Radiological invest it to rule out other pathologies:
Erect CXR - pneumoperitoneum
AXR - intestinal obstruction
Uss in females to rule out gyn

Question 7

Appendicitis tx

Answer 7

Resuscitate

• rehydration
• antibiotics

Appendicectomy

Question 8

Appendiceal mass

Imagining and tx

Answer 8

Confirm with CT
Conservative : Oshner shireen regimen

Allow mass to resolve (~8-12 wks)
Then appendicectomy (interval)

Question 9

Appendiceal abscesses imagining and tx

Answer 9

Confirm with CT
drain abscess: percutaneous, radiological guidance

Treat as an appendiceal mass