Acute Appendicitis Flashcards
What is the pathological process that can lead to acute appendicitis?
- Obstruction of appendiceal lumen by lymphoid hyperplasia or feacal impaction.
- Secretion by epithelium in obstructed appendix leads to distention.
- Distention causes compromise venous outflow, ultimately leading to ischaemia.
- Necrosis and bacterial proliferation in stagnant ischaemic environment may supervene.
- Swelling infection and ischaemia may become transmural leading to gangrene and perforation.
How does appendicitis classically present?
- Initial periumbilical pain
- Develops into localised pain, usually in RIF
- Nausea and vomiting
- Low grade fever and leukocytosis
- If appendix retrocaecal, pain on rectal/pelvic examination
- Appendix can be closely associated with bladder, causing urinary symptoms (dysuria, urgency)
- If peritoneal irritation = rebound tenderness, percussion tenderness, guarding and hyperaesthesia.
What is the classical place at which tenderness is elicited in acute appendicitis?
- McBurney’s point
- A third of the distance between ASIS and umbilicus
What is Rovsing’s sign in acute appendicitis?
Pain in RIF on palpation of LIF
What are the differential diagnoses of acute appendicits?
Intra-abdominal:
- Non-specific mesentetic adenitis
- Meckel’s diverticulitis
- Acute intestinal obstruction
- Acute cholecystitis
- Acute diverticulitis
- Perforated peptic ulcer
- Gastroenteritis
- Acute pancreatitis
Urogential:
- Acute pyelonephritis
- Ureteric colic
- Testicular torsion
Gynae:
- Acute salpingitis
- Ruptured/Torsion of ovarian cyst
- Ectopic pregnancy
CNS:
- Pain preceding eruption of herpes zoster affecting 11th and 12th dorsal segments
What is the treatment of acute appendicitis?
What other actions should be taken before this?
Appendicectomy
Pre-op prep with IV fluids and prophylactic antibiotics
What is the most predictive symptom, sign or serological marker of acute appendicitis?
Tenderness over site of appendix
