Acute Abdomen

Question 1

what is the appendix

Answer 1

small, narrow tube that is connected to the caecum

Question 2

what causes 50% of acute appendicitis cases

Answer 2

luminal obstruction

Question 3

what causes perforation in the appendix

Answer 3

vascular and lymphatic changes due to inflammation leading to ischaemia

Question 4

what is complicated and non-complicated appendicitis

Answer 4

perforated vs non-perf

Question 5

what pain is associated with appendicitis

Answer 5

periumbilical or epigastric pain that migrates to RLQ

Question 6

mx of appendicitis

Answer 6

antibiotics and/or appendicectomy or percutaneous drainage

Question 7

mcburneys point is associated with what disease

Answer 7

appendicitis

Question 8

rovsings sign is related to what disease and what is it

Answer 8

appendicitis + palpation of left iliac fossa causing pain in RIF

Question 9

what bloods in appendicitis

Answer 9

crp, inflammatory markers

serum hcg if woman

Question 10

What age is appendicitis most common

Answer 10

10-20

Question 11

Pathogenesis of appendicitis

Answer 11

Lymphoid hyperplasia/faecolith= obstruction = gut organisms invade = oedema/ischameia = perforation

Question 12

Psoas sign ?

Answer 12

Pain on extending hip if retroceacal appendix

Question 13

Diagnostic steps

Answer 13

1. Raised inflammatory markers
2. Neutrophil predominant leukocytosis
3. Urine analysis (no nitrates, Leuko)
4. Clinical signs, US, CT