Acute Appendicitis

Question 1

Is acute appendicitis serious?

Answer 1

Yes, it’s a medical emergency 🚨

Question 2

What is the basic pathology of acute appendicitis?

Answer 2

Inflammation of the appendix

Question 3

How common is appendicitis?

Answer 3

Affects 1/6

Question 4

Compared to other abdominal emergencies in children, how common is acute appendicitis?

Answer 4

The most common

Question 5

How does acute appendicitis start?

Answer 5

Occlusion of the appendix lumen

Question 6

What often cause the initial obstruction of the appendix lumen?

Answer 6

A faecolith

Question 7

What is a faecolith?

Answer 7

A hard pellet of faeces

-lith = stone

Question 8

How does the initial appendix obstruction present?

Answer 8

Vague abdominal pain

Question 9

Where can vague abdominal pain due to initial appendicitis present?

Answer 9

Around the umbilicus (T10)

Question 10

How does the initial obstruction further develop?

Answer 10

The appendix becomes inflamed, eventually involving the full thickness

Question 11

What can full thickness inflammation of the appendix cause?

Answer 11

Irritation of the peritoneum

Question 12

How does irritation of the peritoneum present?

Answer 12

More severe, localised pain

Question 13

Where does pain due to peritoneal irritation by the appendix present?

Answer 13

The RIF

Question 14

How long can it take for initial appendix obstruction to develop into full thickness inflammation?

Answer 14

6-12 hours

Question 15

What may happen 24-36 hours after onset of RIF pain?

Answer 15

The appendix may become gangrenous and rupture

Question 16

Which gender is acute appendicitis more common in?

Answer 16

Male

Question 17

How does household income affect risk of acute appendicitis?

Answer 17

More common in children from a high income household

Question 18

Living in what area has a higher risk of acute appendicitis?

Answer 18

Living in a rural area

Question 19

What is the typical presentation of early appendicitis?

Answer 19

Vague centralised abdominal pain

Question 20

What is the typical presentation of progressed acute appendicitis?

Answer 20

Severe RIF pain

Question 21

What can aggravate appendicitis pain?

Answer 21

Movement

Question 22

How may a child try to reduce the pain of appendicitis?

Answer 22

Lie still with knees flexed

Question 23

Besides pain what other symptoms may acute appendicitis present with?

Answer 23

• Anorexia (not eating food)
• Vomiting
• Fever

Question 24

What is elicited upon examination of the abdomen in children with acute appendicitis?

Answer 24

Tenderness with guarding in the RIF

Question 25

How is appendicitis usually diagnosed?

Answer 25

Clinically

Question 26

Are lab investigations used in appendicitis?

Answer 26

Not that useful in diagnosis

Question 27

What investigation can be used to support a diagnosis of appendicitis?

Answer 27

USS

Question 28

How accurate is USS in diagnosing appendicitis?

Answer 28

90%

Question 29

What will USS of appendicitis show?

Answer 29

A thickened, non-compressible appendix with increased blood flow

Question 30

What complications may USS be able to show in acute appendicitis?

Answer 30

- Abscess - Perforation - Appendix mass

Question 31

What surgical procedure can be used to assess inflammation of the appendix in some centres?

Answer 31

Laparoscopy

Question 32

What test is abnormal in 1/3 of patient’s with appendicitis?

Answer 32

Urinalysis

Question 33

What aspects of urinalysis are abnormal in 1/3 of appendicitis cases?

Answer 33

- Pyuria | - Bacteriuria

Question 34

In the presence of an abnormal urinalysis, when should antibiotics for suspected UTI be started?

Answer 34

Only if dysuria is present

Question 35

What is the key symptom to consider when forming differential diagnoses for acute appendicitis?

Answer 35

Acute abdominal pain

Question 36

What are some differential diagnoses (other than appendicitis) for acute abdominal pain in children?

Answer 36

- Gastroenteritis - Mesenteric adenitis - Meckel’s diverticulitis - Intsusception - Henoch-Schonlein Purpura - UTI - Abdominal trauma

Question 37

What is the definitive management for appendicitis?

Answer 37

Appendectomy

Question 38

What is suggested if there is generalised guarding?

Answer 38

Perforation

Question 39

What additional management should be given in the case of perforation?

Answer 39

Fluid resuscitation with IV antibiotics prior to laparotomy