Acute Appendicitis Flashcards
Is acute appendicitis serious?
Yes, it’s a medical emergency 🚨
What is the basic pathology of acute appendicitis?
Inflammation of the appendix
How common is appendicitis?
Affects 1/6
Compared to other abdominal emergencies in children, how common is acute appendicitis?
The most common
How does acute appendicitis start?
Occlusion of the appendix lumen
What often cause the initial obstruction of the appendix lumen?
A faecolith
What is a faecolith?
A hard pellet of faeces
-lith = stone
How does the initial appendix obstruction present?
Vague abdominal pain
Where can vague abdominal pain due to initial appendicitis present?
Around the umbilicus (T10)
How does the initial obstruction further develop?
The appendix becomes inflamed, eventually involving the full thickness
What can full thickness inflammation of the appendix cause?
Irritation of the peritoneum
How does irritation of the peritoneum present?
More severe, localised pain
Where does pain due to peritoneal irritation by the appendix present?
The RIF
How long can it take for initial appendix obstruction to develop into full thickness inflammation?
6-12 hours
What may happen 24-36 hours after onset of RIF pain?
The appendix may become gangrenous and rupture
Which gender is acute appendicitis more common in?
Male
How does household income affect risk of acute appendicitis?
More common in children from a high income household
Living in what area has a higher risk of acute appendicitis?
Living in a rural area
What is the typical presentation of early appendicitis?
Vague centralised abdominal pain
What is the typical presentation of progressed acute appendicitis?
Severe RIF pain
What can aggravate appendicitis pain?
Movement
How may a child try to reduce the pain of appendicitis?
Lie still with knees flexed
Besides pain what other symptoms may acute appendicitis present with?
- Anorexia (not eating food)
- Vomiting
- Fever
What is elicited upon examination of the abdomen in children with acute appendicitis?
Tenderness with guarding in the RIF
How is appendicitis usually diagnosed?
Clinically
Are lab investigations used in appendicitis?
Not that useful in diagnosis
What investigation can be used to support a diagnosis of appendicitis?
USS
How accurate is USS in diagnosing appendicitis?
90%
What will USS of appendicitis show?
A thickened, non-compressible appendix with increased blood flow
What complications may USS be able to show in acute appendicitis?
- Abscess
- Perforation
- Appendix mass
What surgical procedure can be used to assess inflammation of the appendix in some centres?
Laparoscopy
What test is abnormal in 1/3 of patient’s with appendicitis?
Urinalysis
What aspects of urinalysis are abnormal in 1/3 of appendicitis cases?
- Pyuria
- Bacteriuria
In the presence of an abnormal urinalysis, when should antibiotics for suspected UTI be started?
Only if dysuria is present
What is the key symptom to consider when forming differential diagnoses for acute appendicitis?
Acute abdominal pain
What are some differential diagnoses (other than appendicitis) for acute abdominal pain in children?
- Gastroenteritis
- Mesenteric adenitis
- Meckel’s diverticulitis
- Intsusception
- Henoch-Schonlein Purpura
- UTI
- Abdominal trauma
What is the definitive management for appendicitis?
Appendectomy
What is suggested if there is generalised guarding?
Perforation
What additional management should be given in the case of perforation?
Fluid resuscitation with IV antibiotics prior to laparotomy
