Acute appendicitis

Question 1

Sx of appendicitis

Answer 1

• periumbilical then RIF pain (max at McBurney’s point)
• anorexia
• N/V
• fever

Question 2

Signs of appendicitis on examination

Answer 2

• tenderness in RIF max at McBurney’s point
• percussion tend, rebound tend, guarding
• Rovsing’s sign
• Psoas sign
• Obturator sign/ Cope’s sign (if retrocaecal)
• tenderness on the R) side in PR exam

Question 3

Investigation for appendicitis

Answer 3

• FBE - elevated neutrophil,
• CRP - elevated

+ clinical sign and symptoms are diagnostic

U/S
CT

laparotomy - rarely needed; in obese case

Question 4

Management for appendicitis

Answer 4

1. prompt appendicectomy
2. IV Abx 1 hr prior OP to reduce wound infection
   - metronidazole
   - cefuroxime

longer course if perforated

3. laparoscopy
   - therapeutic
   - diagnostic in obese/ women
   but contraindicated if gangrenous perforation is suspected as increase risk of abscess formation

Question 5

Complications of appendicitis

Answer 5

1. perforation -> peritonitis
2. appendix mass
3. appendix abscess