Acute Appendicitis

Question 1

What is the function of appendix

Answer 1

Participate in secretion of immunoglobulin

Question 2

Where does the base of appendix located ?

Answer 2

at McBurney’s point.
1/3 distance from right Anterior Superior Iliac Spine (ASIS) to umbilicus
@
lateral 1/3 and medial 2/3 of line between ASIS and umbilicus

Question 3

Blood supply of appendix
-artery
-vein

Answer 3

Appendicular artery and drain into Appendicular vein

Appendicular artery is branch of ileocolic branch of superiopr mesenteric artery

Question 4

Mesoappendix contain what

Answer 4

Appendicular artery
Lymphatic channels (empty to ileocecal lymph nodes)

Question 4

Position of appendix

Answer 4

Commonest –> uncommon
1)Retrocecal
2)Pelvic
3)Paracecal
4)Subcecal
5)Preileal
6)Promontoric
7)Postileal

Question 5

Aetiology

Answer 5

1)Changes in dietary habits
2)Bacterial infections
3)Faecolith

Question 6

Alvarado Score component

Answer 6

Symptoms
* Migratory RIF pain
* Anorexia
* Nausea and Vomiting
Signs
* Tenderness (RIF) -2 points
* Rebound tenderness
* Elevated temperature
Laboratory
* Leukocytosis - 2points
* Left shift of neutrophils

Question 6

Pathophysiology of acute appendicitis

Answer 6

1) Blockage of the appendix leads to accumulation of mucus and bacteria
2) As the inflammation worsens , the appendix swell causing increased pressure and decrease blood flow
3) Pus formed due to accumulation of bacteria and inflammatory cells
4) Blood flow compromise and become gangrenous
5) If rupture (perforated) , can lead to spilling of the content

Question 7

What is the cut off point for alvarado score

Answer 7

Alvarado ≤ 3 = no imaging, unlikely appendicitis
Alvarado 4-6 = recommend CT scan
Alvarado ≥ 7 = surgical consultation

Question 8

On Physical examination , what is your steps

Answer 8

1)Vitals signs
- Temp: low grade fever, rarely increased by >1°C (in children if >38.5°C – ?mesenteric adenitis)
- Heart Rate: normal or slightly elevated

2)Abdominal examination
Signs to elicit
- Rovsing sign: RIF pain with deep palpation of the LIF (indirect tenderness, sign of right-sided local peritoneal irritation)
- Psoas sign: RIF pain with passive right hip flexion (inflamed retrocaecal appendix irritates stretched iliopsoas muscle)
- Obturator sign: RIF pain with internal rotation of a flexed right hip (inflamed pelvic appendix irritates obturator internus muscle)
- Cough sign: RIF pain on coughing (localized peritonitis)

Question 9

Investigation

Answer 9

Biochemical
1)Full Blood Count
-look for leukocytosis
2)Urine Full examination Microscopic Examination
-to rule out UTI
3)Prenancy test
-to rule out ectopic pregnancy

Laboratory
1)Ultrasound of abdomen
- to look for enlarged appendicular diameter (greater than 6mm)
- to look for presence of appendicolith

UTI - hematuria , pyuria ,and fever

Question 10

What is your principle of management

Answer 10

1)symptomatic relief
-antiemetics
-analgesia
2)Surgery
-laparoscopic appendectomy

Question 11

Complication

Answer 11

1)Appendicular mass
2)Appendicular abscess
3)Perforation
4)Gangrene
5)Mucocele