Acute Appendicitis Flashcards
when does it occur?
appendix obstructed by a faecolith or FB in lumen, or lymphoid enlargement in the wall (can follow UTI)
bacteria can proliferate in the closed loop of bowel, eventually leading to necrosis and perforation due to raised intraluminal pressure
symptoms
abdo pain starting dull and central localised and sharp in RIF at McBurney's point constipation anorexia N+V after pain
what is McBurneys point?
1/3 way between ASIS and umbilicus
signs
rebound tenderness in RIF
percuss tenderness
guarding
Rosving’s sign - more painful in RIF than LIF when LIF is pressed
PR painful on RHS (if pelvic appendix or pus in pouch of Douglas)
tachycardia
mild fever, flushing and fetor
tender mass
psoas sign (pain on R hip extension: retroperitoneal retrocaecal appendix)
obturator sign (pain on internal rotation of R hip: pelvic appendix)
differential diagnosis
mesenteric lymphadenitis ruptured ovarian cyst caecal volvulus psoas abscess diverticulitis IBD cancer pyelonephritis Meckel's diverticulum
complications of perforated appendix
peritonitis sepsis appendix mass abscess adhesions infertility
differentials for mass in RIF
inflammatory mass (Appendix mass or abscess) lymphoma crohn's tumour pelvic kidney psoas abscess appendix yersinia/TB
