Acute appendicitis Flashcards
1
Q
What is the pathogenesis?
A
- Primary obstruction of the appendix lumen (faecolith, lymphoid hyerplasia, filarial worms)
- Fills with mucus and swells
- Pressures result in thrombosis and occlusion of the small vessels, and stasis of lymphatic flow
2
Q
What are the symptoms?
A
- Periumbilical colicky pain to RIF constant pain
- Gradual onset
- Anorexia
- Vomiting someimes after pain
- Constipation
- Diarrhoea
General symptoms;
- Tachycardia
- Fever
- Furred tongue
- Lying still
- Coughing hurts
- Foetor +/- flushing
- Shallow breaths
- RIF
- Guarding
- Rebound + percussion tenderness
- PR pain on right
3
Q
What are some signs of appendicitis?
A
- Rovsing’s sign
- RIF pain when LIF pressed
- Psoas sign
- Pain lifting hip against resistance = retrocaecal appendix
- Cope sign [obturator sign]
- Pain flexing and internal rotating right hip = appendix close
4
Q
What is Rovsing’s sign?
A
RIF pain when LIF pressed
5
Q
What is Psoas sign?
A
Pain lifting hip againt resistance = retrocaecal appendix
6
Q
What is Cope/ obturator sign?
A
Pain flexing and internal rotating right hip = appendix close
7
Q
Why might there be flank/ RUQ pain?
A
2.5% are retrocecal/ peritoneal
Only sign is right pain in PR
8
Q
What investigations are important?
A
- Raised WBC
- Pregnancy test (exclude ectopic pregnancy)
- Abdominal X-Ray for ecluding ureteric calculus
- Mid-stream urine (MSU) to exclude UTI
- CRP will be raised but is non-specific
- Pelvic ultrasound for gynaecological pathology
- CT scan is sensitive and specific
9
Q
What are complications of appendicitis?
A
- Perforation
- Common with faecolith + young children (diagnosed late)
- Appendix mass
- Inflamed appendix covered with omentum
- Appendix abscess
10
Q
What is the treatment of acute appendicitis?
A
- Prompt appendicectomy
- Antibiotics
- Laparoscopy is good (except in gangrenous)
