**ACC (Y4)** Abdominal: Appendicitis

Question 1

what part of the bowel is the appendix attached to?

Answer 1

caecum

Question 2

what causes appendicitis?

Answer 2

It is thought to be caused by:

infection secondary to obstruction of the lumen of the appendix, usually by a faecolith (hard mass of faecal matter), normal stool, and/or lymphoid hyperplasia secondary to viral infection.

Question 3

what are the risk factors for appendicitis?

Answer 3

• male gender
• frequent antibiotic use
• smoking
• ethnicity (more common in caucasians)

Question 4

which ethnicity is appendicitis more common in?

Answer 4

caucasians

Question 5

what is the most common ages appendicitis occurs?

Answer 5

between ages 10 - 20 years

Question 6

what are classical clinical features of appendicitis?

Answer 6

• abdopain
• anorexia
• nausea
• constipation
• vomiting (if profuse, may indicate peritonitis)
• tenderness over mcburney’s point
• guarding in the right iliac fossa
• tachypnoeic
• pyrexia
• rousing’s sign
• psoas sign

Question 7

what is McBurney’s point?

Answer 7

The point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus (navel).

• corresponds to the most common location of the base of the appendix where it is attached to the cecum.

Question 8

what is rovsing’s sign?

Answer 8

If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing’s sign and may have appendicitis.

Question 9

what is psoas sign?

Answer 9

RIF pain with extension of the right hip

Question 10

is your appendix on the left or right side of the abdomen?

Answer 10

right iliac fossa

Question 11

in which type of people may appendicitis not present typically?

Answer 11

• young children
• pregnant women
• elderly

Question 12

what investigations would you do to diagnose appendicitis?

Answer 12

NB: no specific investigations to diagnose, but there are tests to exclude other causes of abdo pain:

• pregnancy test
• Urine dipstick (UTI)
• FBC/CRP (infection)

Question 13

what is the treatment for appendicitis?

Answer 13

appendectomy

Question 14

what are complications of an appendectomy?

Answer 14

• haemorrhage,
• injury to surrounding structures,
• conversion to open surgery including full laparotomy,
• general anaesthesia.

Question 15

what are the complications of an untreated appendicitis?

Answer 15

• appendix perforation
• generalised peritonitis
• appendix mass or abcess
• adhesions
• sepsis
• death