Acute appendicitis Flashcards
What is appendicitis?
Inflammation of the appendix
Which age is most commonly affected by appendicitis?
2nd/3rd decade
What is the overall lifetime risk of appendicitis
7-8%
What is the typical cause of appendicitis?
Direct luminal obstruction usually secondary to a faecolith or lymphoid hyperplasia, impacted stool or rarely an appendiceal or caecal tumour
What happens when the appendix becomes obstructed?
Commensal bacteria multiply, resulting in acute inflammation
Reduced venous drainage and localised inflammation can result in increased pressure within the appendix and in turn can result in ischaemia
What happens to the appendix if appendicitis is left untreated?
Necrosis and then perforation
List some risk factors for appendicitis
Family history - 30% risk in twin studies
Ethnicity - more common in Caucasians
Environmental - seasonal presentation - during the summer
List the symptoms of appendicitis
Abdominal pain - peri-umbicilcal, dull and poorly localised (from visceral peritoneum inflammation) but later migrates to the right iliac fossa where it is localised and sharp
Vomiting
Anorexia
Nausea
Diarrhoea or constipation
What is seen on examination of appendicitis?
Rebound tenderness Percussion pain over McBurneys point Guarding Sepsis signs - tachycardic and hypotensive RIF mass in case of appendiceal abscess
Name two specific signs of appendicitis
Rovsing’s sign
Psoas sign
Describe Rovsing’s sign
RIF pain on palpation of the LIF
Describe psoas sign
RIF pain with extension of the right hip - suggests inflamed appendix abutting psoas major muscle in retrocaecal position
Where is McBurney’s point?
Two thirds of the way between the umbilicus and ASIS
How may appendicitis present in children compared to adults
Atypically
Diarrhpea, urinary symptoms or left sided pain
List the differentials for appendicitis
Gyanecological - ovarian cyst rupture, ectopic, pelvic inflammatory disease
Renal - ureteric stones, UTI, pyelonephritis
Gastrointestinal - IBD, Meckel’s diverticulum or acute mesenteric adenitis, gastroenteritis, constipation
Urological - testicular torsion, epididymo-orchitis
What investigations should be ordered for appendicitis
Urinanalysis Pregnancy test for those of reproductive age FBC CRP Cross match, Group and save U&Es LFTs Imaging - ultrasound or CT imaging
Name the risk stratification score used for appendicitis in children
Shera score
What is the current definitive treatment for appendicitis?
Laparoscopic appendicectomy and appendix sent for histopathology
What is the treatment for an appendiceal mass?
Antibiotic therapy - interval appendectomy performed 6-8 weeks later
When is an open approach used?
During pregnancy
What is the name of the incision in the open approach?
Lanz incision
List the complications of appendicitis
Perforation
Surgical site infection
Appendix mass
Pelvic abscess
