Acute Appendicitis

Question 1

Pathogenesis of appendicitis

Answer 1

Gut organisms invade appendix wall, caused by lymphoid hyperplasia, faecolith or infections
Leads to oedema, ischaemic necrosis and perforation

Question 2

Presentation of appendicitis

Answer 2

Periumbilical pain moving to RIF (usually, can be RUQ pain very rarely), eventually localises at McBurney’s
Elderly may not show pain but be shocked
Anorexia (children stop eating favourite food)

Question 3

Diagnostic tests of appendicitis

Answer 3

Raised WCC + CRP

CT has high diagnostic accuracy

Question 4

Treatment of appendicitis

Answer 4

Appendicectomy (laproscopic unless suspected gangrenous perforation due to greater ulceration)
Piperacillin/tazobactam

Question 5

Complications of appendicitis

Answer 5

Perforation - more common with faecolith
Appendix mass - inflamed appendix covered with omentum, can wait to see if resolves or not
Appendix abscess - mass fails to resolve, enlarges and patient deteriorates so drainage may be needed