Acute appendicitis

Question 1

What age is appendicitis highest?

Answer 1

10-20yrs

Question 2

Why is it rare in ages <2yrs

Answer 2

appendix is cone shaped w larger lumen

Question 3

what is the pathogenesis underlying appendicitis?

Answer 3

gut organisms invade the appendix wall after lumen obstruction,
leads to oedema, ischaemic necrosis and perforation

Question 4

what can cause obstruction of lumen of appendix?

Answer 4

lymphoid hyperplasia
faecolith
filarial worms

Question 5

what are the sx

Answer 5

periumbilical pain radiatie to the RIF due to localised parietal peritoneal inflammation
pain worse on coughing, going over speedbumps
children can’t hop on right leg
anorexia
constipation
mild pyrexia
nausea
furred tongue (sign of indigestion or fever)

Question 6

why does the pain start off as periumbilical

Answer 6

visceral stretching of appendix lumen and appendix is midgut structure

Question 7

What can be found on examination? include special tests

Answer 7

Rovsing’s sign - palpation in LIF causes pain in RIF (limited value)
Psoas sign - pain on extending hip if retrocaecal appendix
PR painful on right (sign of low lying pelvic appendix)

Question 8

what investigations would u do and what would be found?

Answer 8

1. FBC - neutrophil leuocytosis, raised ESR
2. US
3. CT - if diagnosis unclear

Question 9

What position are the majority of appendices in?

Answer 9

retrocaecal

Question 10

hOW CAN it present in a child?

Answer 10

vague abdo pain off their food

Question 11

how can It present in a person in their 80s?

Answer 11

shocked and confused but no pain

Question 12

What is the treatment?

Answer 12

appendicectomy
abx - metronidazole + cefuroxime
laparoscopy

Question 13

What are then complications of appendicitis?

Answer 13

perforation
appendix mass
appendix abscess