Appendicitis

Question 1

Define appendicitis

Answer 1

Inflammation of the appendix. Most common medical emergency

Question 2

Pathology of appendicitis

Answer 2

1. Obstruction of the lumen from faecolith (hard mass of faeces) causes gut flora to invade appendix wall
2. Inflammation and infection leads to oedema, ischaemic necrosis and perforation
3. Liable to perforation, letting infected matter and faeces into the peritoneal cavity -> peritonitis
4. Alternatively could form an appendix absces

Question 3

Symptoms of appendicitis

Answer 3

1. Periumbilical pain that moves to the RIF
2. Vomiting
3. Diarrhoea
4. Loss of appetite

Question 4

Signs of appendicitis

Answer 4

1. Fever
2. Tachycardia
3. Rebound and percussion tenderness in RIF
4. Rovsing’s sign - more pain in RIF than LIF when LIF is pressed
5. Psoas sign - pain on extending hip (if retrocaecal appendicitis)

Question 5

Investigations for appendicitis

Answer 5

1. Bloods - CRP elevated, neutrophil leucocytosis
2. US can be useful, appendix not always visualised
3. CT - gold standard - high diagnostic accuracy

Question 6

Management of appendicitis

Answer 6

1. Appendicectomy - open or laparoscopic

2. IV antibiotics - piperacillin/tazobactam

Question 7

Complications of appendicitis

Answer 7

1. Peritonitis

2. Appendix abscess