Acute appendicitis Flashcards
Anatomy of appendix
- Location
- blood supply
Pouch, blind ended, off the caecum
- around 5-10cm
Originally a foregut structure
Location
- Most commonly retrocaecal
- Others: pelvic, retroileal, retrocolic
Blood supply
- Small mesentery= appendicular artery
- Terminal branch of ileocolic, if thrombosis occurs, can cause gangrene
Acute appendicitis
- Definition
Inflammation of appendix most likely due to obstruction
- Faecolith
- stool
- Infective agents
- Lymphoid hyperplasia
Types
- Simple/ non-perforated
- Perforated
Risk factors
Age
- 10-20
M>F
Frequent antibiotic use
Low fibre
Smoking
Complications of appendicitis
Perforation—> generalised peritonitis
Appendix mass/ abscess
Adhesions
Sepsis
Symptoms of appendicitis
Abdominal pain
- Peri-umbilical/ epigastric, migrates to RIF
- Pain moves when abdominal wall peritoneum becomes inflammed
- Worsened by movement
Anorexia
Nausea
Constipation
Vomiting
- Sign of more severe
Investigations for appenditicitis
Bloods
- FBC = Increased WCC
- U+E= Na, K
- CRP= raised, esp with WCC
Abdominal + pelvic CT
- Wall thickening and enhancement of appendix
Abdominal USS if CT not suitable
Pregnancy test and urinalysis to rule out other differentials.
Management of appendicitis
NBM and IV
- Analgesia
Appendicectomy
- Lap or open
- Co-amoxiclav initially, continue if perforation is indicated
Appendicectomy
Lap
- Uncomplicated, complicated and perforated
Open
- Better for pregnant women
Follow up
- Short recovery time (1 day)
Appendicectomy
Lap
- Uncomplicated, complicated and perforated
Open
- Better for pregnant women
Follow up
- Short recovery time (1 day)
Appendicectomy
- Complications
Perforation
Generalised peritonitis
Appendicular mass or abscess
Wound infection
Classifications
Mucosal
- Mildest
Phlegmonous
- Slow onset, slow progression
Necrotic
- Acute bacterial infection cause
- Ischaemic necrosis
- High perforation risk
Signs
Fever
Tachycardia
Abdominal tenderness
- Especially at McBurney’s point
- Guarding= peritonism, perforation
Rovsing’s sign
- palpating LIF makes pain worse in RIF
