Appendicitis Flashcards
state the typical presentation of appendicitis?
Central to RIF, guarding and percussion tenderness, fever, knees to chest position – straight to diagnostic laparoscopy (+ appendicectomy)
define appendicitis?
inflammation of appendix
summarise the epdiemiology of appendicitis?
The MOST COMMON surgical emergency
Can occur at any age
Most commonly occurs between 10-20 yrs
outline the aetiology of appendicitis?
Gut organisms(usually E.coli and Streptococcus) invade the appendix wall after lumen obstruction (e.g. by lymphoid hyperplasia, faecolith (stone made of faecses) or filarial worms)
This leads to oedema, ischaemic necrosis and perforation
what are the presenting symptoms of appendicitis?
Periumbilical pain that moves to the right iliac fossa – this is because the initial pain is due to inflammation of the visceral peritoneum and appendix itself and visceral pain tends to be poorly localised and the pain is referred to the midline. As the inflammation spreads to the parietal peritoneum, which is somatosensory, it is localised at the right lower quadrant – the point of pain is known as MCBURNEY’S POINT( 1/3 of the distance from the ASIS to the umbilicus – roughly corresponds to location of base of appendix)
Anorexia-> important feature
Vomiting (may occur after pain)
Constipation
Diarrhoea
what are the signs of appendicitis on physical examination?
General Signs
- Tachycardia
- Fever
- Furred tongue
- Lying still
- Coughing hurts
- Foetor with/without flushing
- Shallow breaths
RIF Signs
- Guarding
- Reboundand percussion tenderness
- PR pain on the right side (sign of low-lying pelvic appendix)
what are the special signs for appendicitis?
Rovsing’s Sign- palpation of the left iliac fossa causes more pain in the right iliac fossa than the left
Psoas Sign-pain on extending the hip (caused by retrocaecal appendix)- SO IN THE KNEES TO CHEST POS!!!
Cope/Obturator Sign- pain on flexion and internal rotation of the hip (occurs if the appendix is in close proximity to the obturator intecentrarnus) Variations in clinical picture
what is the socring system for appendicitis?
Alvarados score
what are the appropriate investigations for appendicitis?
FBC- high WCC
CRP- elevated
pregnancy test
CT - high diagnostic accuracy but may cause fatal delay – usually go straight to surgery for diagnostic laparoscopy+/- appendicectomy
Ultrasound/ MRI (if preg) and urinalysis may help
outline a management plan for appendicitis?
appendidectomy
metronidazole: 500 mg intravenously every 8 hours
what are the possible complications of appendicitis?
Perforation
- More common with faecolith involvement e.g. in children
Appendix mass
- Occurs when the inflamed appendix becomes covered with omentum
Appendix abscess
- May occur if appendix mass fails to resolve
- Treatment involves drainage and antibiotics
summarise the prognosis for patients with appendicitis?
- Uncomplicated appendicitis - most people recover with no long-term problems
- Ruptured appendix - greater risk of complications/death
