Acute appendicitis Flashcards
What is appendicitis?
Inflammation of the appendix
What causes appendicitis?
Direct luminal obstruction
What usually blocks the lumen in appendicitis?
Faecolith usually but can be lymphoid hyperplasia, impacted stoop or appendiceal or caecal tumour
What are the risk factors for appendicitis?
Family history e.g. twins, ethnicity- caucasians but ethnic minorities more likely to perforate if they do have it, environmental- during summer
What is main symptoms of appendicitis?
Abdominal pain that begins peri umbilical, dull and poorly localised but migrates to the right iliac fossa and the pain is well localised and sharp. Vomiting after the pain, anorexia, nausea, diarrhoea, constipation
What can be found on examination of someone with appendicitis?
Tachycardic, tachypnoeic, pyrexial, rebound tenderness, percussion pain over Mcburneys point and potential guarding, may have abscess in RIF mass
What is Rovsing sign?
RIF fossa pain on palpation of the LIF which is present in appendicitis
What is Psoas sign?
RIF pain with extension of the right hip which is present in appendicitis
What are the differential diagnosis of appendicitis?
ectopic pregnancy or ovarian cyst rupture, ureteric stones, UTI, pyelonephritis, mesenteric adenitsis, diverticulitis, inflammatory bowel disease, Meckels Diverticulum, Testicular torsion, epidymo-orhcitis, pelvic inflammatory disease
What laboratory tests should be done for acute appendicitis?
Urinalysis to exclude renal causes, pregnancy test, routine bloods to look for raised inflammatory markers, serum BHCG if ectopic pregnancy is still not excluded
What imaging should be done for acute appendicitis?
Should be a clinical diagnosis but a trans abdominal ultrasound or CT scan if unsure
What is the AIR score?
appendicitis inflammatory response score which triage patients into low, intermediate or high risk
What are the things looked at on the AIR score?
Vomiting, RIF pain, pyrexial, WBC, leukocytes, CRP, rebound tenderness or guarding
What is the management for acute appendicitis?
Laparoscopic appendicectomy
What is the debate surrounding conservative treatment for laparascopic appendectomy?
Antibiotic therapy can be used in uncomplicated appendicitis but does have a failure rate of 25-30% at 1 year
