Acute appendicitis

Question 1

What is appendicitis

Answer 1

Inflammation of the appendix (arising from caecum)

Question 2

Appendicitis pathophysiology

Answer 2

Pathogens can get trapped due to obstruction at the point where the appendix meets the bowel. Results in infection and inflammation.
Can lead to gangrene and rupture

Question 3

Appendicitis presentation

Answer 3

10-20yrs
Initial central abdominal pain that migrates to the right iliac fossa, becoming localised pain.
Tenderness at McBurney’s point (1/3 from ASIS to umbilicus)
Rovsing’s sign +ve
Loss of appetite
Nausea and vomiting
Low grade fever
Abdo guarding on palpation
Rebound (and percussion) tenderness in RIF (can also indicate peritonitis)

Question 4

Appendicitis differentials

Answer 4

Ectopic pregnancy
Ovarian cysts
Meckel’s diverticulum
Mesenteric adenitis (inflamed abdominal lymph nodes)

Question 5

Appendicitis investigations

Answer 5

hCG to exclude pregnancy
USS or CT if old
Can perform a diagnostic laparoscopy and potential appendicectomy from there if needed
Mainly diagnosed through history and examination

Question 6

Appendicitis management

Answer 6

Emergency admission under surgical team

Appendicectomy

Question 7

Appendicitis complications

Answer 7

Peritonitis
Perforation
Sepsis 
Wound infection, pain, bleeding and scars
Damage to bowel, bladder or other organs
Removal of a normal appendix
Anaesthetic risks
VTE