Acute appendicitis

Question 1

Epidemiology of acute appendicitis

Answer 1

6% lifetime incidence
Most common surgical emergency
Children

Question 2

Pathogenesis of acute appendicitis

Answer 2

1) Obstruction: Faecolith (most common)
2) Infection behind obstruction
3) Oedema –> Ischaemia –> Necrosis –> Perforation

Question 3

Pain in appendicitis

Answer 3

Early: Umbilical (T10/11) lesser splanchnic nerve
Late: RIF pain (peritonitic)

Question 4

Symptoms of appendicitis

Answer 4

Colicky abdo pain worse on movement
Anorexia
Nausea
Constipation/diarrhoea

Question 5

Signs of acute appendicitis

Answer 5

Signs of infection (temp, raised HR)

Pain and guarding McBurney’s point

Question 6

Rovsing’s sign

Answer 6

Acute Appendicitis:

Pressure in LIF leads to pain in RIF

Question 7

Psoas Sign

Answer 7

Acute Retrocaecal appendix:

Pain on extending hip

Question 8

Cope sign

Answer 8

Acute appendicitis close to obturator internus:

Flexion + Internal rotation of R hip

Question 9

Differential diagnoses of acute appendicitis

Answer 9

Cholecystitis
Diverticulitis
Meckel's Diverticulum
Ruptured ectopic
Salpingitis
UTI 
Crohn's
Mesenteric adenitis

Question 10

Investigations for appendicitis

Answer 10

Bloods: FBC, CRP, amylase
Urine: B-HCG (ectopic)
Imaging: Ultrasound or CT
Diagnostic laparoscopy

Question 11

Treatment of acute appendicitis

Answer 11

Fluids
Ceftriaxone and Metronidazole IV
Analgaesia
Appendectomy (open or laparoscopic)

Question 12

Complications of acute appendicitis

Answer 12

Appendix mass
Appendix abscess
Perforation