Acute Appendicitis

Question 1

at what age is appendicitis most common?

Answer 1

10-20 yrs

Question 2

pathogenesis of appendicitis?

Answer 2

gut organisms invade appendix wall after lumen obstruction

lumen obstruction can be caused by lymphood hyperplasia or fecaliths (hard stony mass of faeces)

leads to oedema, ischaemic necrosis and perforation

Question 3

where does pain start and then radiate to?

do you get a fever?

Answer 3

umbilical region then moves to RIF

yes

Question 4

what is rovsing’s sign?

Answer 4

pain in RIF when LIF is pressed

Question 5

what is psoas sign?

Answer 5

pain on hip extension (retrocaecal appendix)

Question 6

what is obturator sign?

Answer 6

pain of flexion/internal rotation of hip

Question 7

if you get inflammation in retrocaecal/retroperitoneal appendix (2.5% of pts) what features would you get?

Answer 7

flank or RUQ pain

or only sign may be tenderness on right in PR exam

Question 8

which imaging technique has high diagnostic accuracy?

Answer 8

CT

Question 9

what happens to CRP?

Answer 9

raised

Question 10

Tx for Appendicitis?

Abx?

Answer 10

NBM
Prompt appendicectomy

Piperacillin/Tazobactam reduce wound infections

Question 11

complications of appendicitis?

Answer 11

1. perforation (commoner in children)
2. appendix mass - when inflamed appendix is covered in omentum
3. appendix abscess - if appendix mass fails to resolve + enlarges - tx involves drainage

Question 12

Scoring system used for appendicitis?

Answer 12

Alvarado scoring system