Appendicitis Q1 Flashcards
(5 cards)
Symptoms
Abdominal pain
Periumbilical/epicanthic pain thta worsens and migrates to the right lower quadrant of the abdomen over 24-48 hours
Pain that is often worsened by movement such as coughing or driving over uneven roads
Fever (often low grade)
General malaise
Loss of appetite
Nausea and vomiting
Constipation or sometimes diarrhoea
A history of sudden pain relief may indicate appendiceal perforation
Overview
Acute inflammation of the veriform appendix - a blind sac located near the end of the caecum
The function of the appendix is not fully understood but it has a high concentration of gut-associated lymphoid tissue meaning it may act as a reservoir for normal gut flora, allowing the large bowel microbiome to recover after enteric infections (NICE, 2021)
Appendicitis typically presets acutely within 24 hours of onset but can present as a more chronic condition
Initially presents with generalised or periumbilical abdominal pain that later localises to the right lower quadrant
May be uncomplicated (non-perforating) or complicated (perforating) - perforation is defined by a visible hole in the appendix
Appendiceal perforation is associated with increased morbidity and mortality compared with non-perforating acute appendicitis
Causes
Main cause of appendicitis is obstruction at the point where the appendix meets the bowel as this allows pathogens to build up in the appendix
The main causes of luminal obstruction are thought to be faecolith (hard mass of faecal matter), lymphoid hyperplasia during an infection, impacted stool, foreign body and rarely appendiceal or caecal tumour
Genetic and environmental factors may also have an impact as well as infection and malignancy
Pathophysiology
Likely stems from obstruction of the appendiceal orifice, the background of the obstruction might differ for different age groups
Lymphoid hyperplasia (increase in the number of normal cells contained in the lymph nodes) can result in inflammation, localised ischemia, perforation and the development of a contained abscess or perforation which may result in peritonitis
Once obstructed, the appendix fills with mucus and becomes distended and as lymphatic and vascular compromise advances, the wall of the appendix becomes ischemic and necrotic
Once significant inflammation and necrosis occur, the appendix is at risk of perforation, leading to a localised abscess and sometimes peritonitis
Epidemiology
One of the most common cases of acute abdominal pain in children and adults (Di Saverio, 2020)
The pooled incidence of appendicitis or appendicectomy was 151 per 100,000 people in Western Europe from 2000 onwards
The world society of emergency surgery reports that in developed countries, acute appendicitis occurs at a rate of 5.7–50 pateints per 100,000 inhabitants per year, with a peak between the ages of 10 and 30 years (Di Saverio, 2020)
Expert opinion notes a lifetime risk of 8.6% in males and 6.7% in females (Synder, 2018)
Expert opinion in a review article notes that acute appendicitis is very rare in children less than 1 year of age (Marzuillo, 2015)
The rate of perforation varies from 16-40% with a higher frequency occurring in younger age groups and in older people than 50 years of age
Expert opinion in a review article notes that young children and those with increased duration of symptoms are at a higher risk of perforation (NICE, 2021)
