Acute appendicitis Flashcards

1
Q

List the symptoms and signs of acute appendicitis

A

Symptoms:

  • Abdominal pain, starting dull and central before becoming localised and sharp in the RIF at McBurneys point (1/3rd of the way between the ASIS and the umbilicus)
  • Constipation (or sometimes diarrhoea)
  • Anorexia
  • Nausea & vomiting (after the pain)

Signs:

  • Rebound (when examiner moves hand away) tenderness in RIF
  • Percussion tenderness
  • Guarding
  • Rosving’s sign (more painful in RIF than LIF when LIF pressed)
  • Tachycardia
  • Mild fever, flushing and fetor
  • Tender mass (ocassionally)
  • Psoas sign (pain on R hip extension: retropertioneal retrocaecal appendix)
  • Obturator sign (pain on internal rotation of R hip: pelvic appendix)
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2
Q

What other conditions that mimic acute appendicitis?

(other differential diagnosis’)

A
  • Mesenteric lymphadenitis (inflammation of lymph nodes)
  • Ovarian cyst rupture
  • Eptopic pregnancy
  • Caecal volvulus
  • Psoas abscess
  • Diverticulitis
  • IBD
  • Cancer
  • Pyelonephritis
  • Meckel’s Diverticulum
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3
Q

What investigations would you do for a patient with suspected acute appendicitis?

A
  • PR (rectal examination)
  • Pelvic examination in females
  • Pregnancy test
  • Bloods: FBC, U&E, CRP/ESR
  • Urinalysis
  • USS/CT - if diagnostic uncertainity
  • AXR/erect CXR - if questioning perforation

This diagnosis is made clinically and there usually isnt the need for all these tests (esp AXR/erect CXR and USS/CT)

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4
Q

What labatory findings would tend to confirm the diagnosis of acute appendicitis?

A

Raised WBC

Raised CRP

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5
Q

List the complications of a perforated appendix

(5)

A
  • Peritonitis & sepsis (septicaemia)
  • Appendix mass - inflamed appendix becomes covered with omentum
  • Appendix abscess - Local/pelvic/subhepatic/subphrenic: develop if appendix mass fails to resolve
  • Adhesions (fibrous bands that form between tissues and organs)
  • Infertility - due to tubal obstruction after pelvic infection
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6
Q

What are common complications following an appendicetomy?

A

Early complications:

  • Haematoma( a solid swelling of clotted blood within the tissues)
  • Wound infections

Late complications:

  • Small bowel obstruction (adhesions)
  • Incisional hernia
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7
Q

What are the possible differenial diagnosis’ for a mass in the right iliac fossa?

A
  • Inflammatory mass (appendix ass/abscess)
  • Lymphoma
  • Crohn’s disease - Repeated inflammation and fibrosis may cause a thickening
  • Tumour mass (caecal/carcinoid)
  • Pelvic kidney - transplanted in RIF as external iliac vessels are easy to construct anastomosis with the existing renal vasculature stubs
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8
Q

How is the cause of a mass in the RIF diagnosed?

I.e what investigations are required?

A
  • USS/CT to confirm diagnosis (use clinical signs to make inital diagnosis)
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9
Q

How is a mass in the RIF managed?

(after USS/CT to confirms diagnosis)

A
  • Conservative management
    • IV cefuroxime and metronidazole, marking out the size of the mass to see if it develops into an abscess
  • If the mass does not resolve (20% enlarge in a toxic patient), perform percutaneous drainage of abscess
  • After resolution, interval appendectomy is usually carried out at three months due to the risks of further attacks
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10
Q

What is a carcinid tumour?

Describe in detail

(not one of the objectives)

A
  • Tumours of argentaffin cells, which produce physically active substances such as serotonin/prostaglandins
  • They can often occur on the tip of the appendix, and 10% of tumours may be assoiciated with MEN-1 syndrome
  • They charactistically take up silver stains very readily
  • Usually present after the fourth decade with carcinoid syndrome (flushing of the face and diarrhoea due to the endocrine products)
  • Prognosis is generally good, and the tumour is generally resectable
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