Acute Appendicitis Flashcards
Where is the appendix?
- end of caecum
- posterior and medial to it
Different positions of the appendix?
Pre-ileal (anterior to terminal ileum) Post -ileal (post to terminal ileum) Sub ileum (parallel with it) Pelvic (descends over pelvic brim) Sub-caecal (below caecum) Para-caeceal (parallel) Recto-caecal (behind caecum) = most common
Classic presentation of appendicitis
Initial pain in central abdomen Migrates to RIF Anorexia is common With tachycardia, low grade fever, tenderness in RIF Rosving's sign
Alternative Presentation of acute appendicitis
Vomiting
Rosvings
Psaos sign
Obturator/Cope sign
What is Psoas sign
If acute retrocaecal appendicitis
Pain on extension of thigh
Irritation of peritoneal posterior to iliopsoas group of hip flexors in abdomen
Perforates Appendicitis
Symptoms >48 hours
Appear acutely ill
Dehydration
Electrolyte abnormalities (esp if fever & vomiting)
Ix
- pregnancy test
- WCC
- CRP
- amylase
- urine dipstick
Imaging modalities
CT Abdo/Pelvis = always unless pregnant
US Abdo
MRI
What is seen on a CT?
- wall thickening
- inflammatory changes in surrounding tissues
- always done unless pregnant
When is an abdo US done?
- if atypical presentation
- children
- pregnancy
When is an MRI done?
Pregnancy if USS inconclusive
McBurney’s point define
1/3 between ASIS and umbilicus
Tenderness here
Management of appendicitis
Appendectomy
What can cause obstruction of the appendix?
- lymphangitis
- appendicolith
- foreign body
- worms
What causes increased pressure in appendix wall?
- venous stasis
- thrombosis
- lymphatic obstruction
- swelling
