Acute Appendicitis Flashcards
When is the highest incidence age range for Acute Appendicitis?
10-20 years
What is the pathophysiology of Acute Appendicitis?
Acute inflamm of appendix bc obstruction of lumen bc:
- Faecolith
- Impacted (stuck) stool
- Lymphoid hyperplasia
- Tumour (rare)
What is a faecolith?
Hard stony mass of faeces
What is the most common cause of Acute Appendicitis in adults?
Faecolith
Why is impacted (stuck) stool a more common cause of Acute Appendicitis in children?
Higher rates of constipation
What is a lymphoid hyperplasia?
Hyperplasia of the submucosal lymphoid follicles
What is the most common cause of Acute Appendicitis in children?
Lymphoid hyperplasia
What is the most common cause of lymphoid hyperplasia?
Viral infection
How does lumen obstruction lead to appendicitis and eventually peritonitis? (8 steps)
- Lumen obstruction
- Lumen fills with mucus
- Increased intraluminal pressure
- Reduced blood flow to appendix
- Resident bacteria in appendix multiply (B.fragilis and E.coli)
- Inflamm + ischaemia of appendix (appendicitis)
- Perforation
- Peritonitis
What is the most common presentation of Acute Appendicitis?
Abdominal pain
Starts off as dull + poorly-localised peri-umbilical / epigastric pain –> sharper + migrates to RIF within 1-12 hours
Is the abdominal pain in Acute Appendicitis worse on movement?
Yeah
What clinical features can you find on examination of a patient of Acute Appendicitis? (3 things)
- Rebound tenderness
- Guarding
- Percussion pain
@ McBurney’s Point (2/3 of way between umbilicus & ant. sup. iliac spine)
What clinical features can be seen in SEVERE cases of Acute Appendicitis?
Sepsis features
- Tachycardia
- Hypotension
- Appendiceal abcess + RIF mass
What are the specific signs of Acute Appendicitis on examination? (2 things)
- Rovsing’s Sign
- Psoas Sign
What is Rovsing’s Sign?
RIF pain @ palpation of LIF
(sign of acute appendicitis)
What is Psoas Sign?
RIF pain @ extension of right hip
(sign of acute appendicitis)
What does the Psoas Sign suggest?
Inflam appendix touching psoas major muscle in retrocaecal position
What symptoms of Acute Appendicitis can present AFTER the pain?
- Nausea + vomiting
- Anorexia
- Low grade fever
If you suspect Acute Appendicitis and patient has HIGH grade fever, what’s up den?
It’s probs Peritonitis or stn else cah Acute Appendicitis only has LOW grade fever
What lab investigations should be done for suspected Acute Appendicitis?
- FBC = reveals neutrophil leucocytosis in 80-90% of cases
- CRP = elevated
- Urinalysis = to exclude UTI
- Pregnancy test = to exclude pregnancy / ectopic pregnancy
Is imaging required for Acute Appendicitis diagnosis?
No but useful if other tests inconclusive
What imaging should be done Acute Appendicitis?
- CT
- US
Why is a CT scan useful in Acute Appendicits? (2 things)
- 94% sensitivity + 95% specificity in acute appendicitis diagnosis
- Minimises likelihood of -ve appendicectomy
What is -ve appendicectomy?
Appendicectomy in which surgeon discovers there is NO appendicitis
Why is an US scan useful in Acute Appendicits? (2 things)
- Good first line imaging if radiation is concern (e.g children / pregnant)
- Good if suspected gynaecological differentials
What gynaecological conditions present similarly to Acute Appendicitis? (3 things)
- Ectopic pregnancy
- Ovarian torsion
- Pelvic inflamm disease