Acute appendicitis

Question 1

What is acute appendicitis?

Answer 1

Acute inflammation of the appendix, typically due to an obstruction of the appendiceal lumen

Question 2

What causes acute appendicitis?

Answer 2

Obstruction of the appendiceal lumen due to:
Lymphoid tissue hyperplasia
Fecalith and fecal stasis

Question 3

What is the pathophysiology of acute appendicitis?

Answer 3

Stasis of mucosal secretions → bacterial multiplication and local inflammation
Increased intraluminal pressure → obstruction of veins → edema of the appendiceal walls → obstruction of capillaries → ischemia

Question 4

What are the clinical features of appendicitis?

Answer 4

Migrating abdominal pain (constant and rapidly worsens, initially diffuse periumbilical then localised to RLQ)
Nausea
Anoerxia
Vomiting
low grade fever
Change in bowel habits
(Clinical signs) McBurney point tenderness (lateral third and medial two-thirds of a line drawn from the right anterior superior iliac spine to the umbilicus)

Question 5

How is acute appendicitis diagnosed?

Answer 5

Often clinical
(Laboratory tests)Inflammatory markers: ↑ CRP, mild leukocytosis
(Imaging) Abdominal ultrasound, abdominal CT

Question 6

What is the treatment for acute appendicitis?

Answer 6

Bowel rest, analgesia, antibiotics with anaerobic + gram negative cover (e.g., cefazolin and metronidazole) +
Appendectomy

Question 7

What are some differential diagnosis for appendicitis?

Answer 7

Ectopic pregnancy
Pseudoappendicitis (Caused by mesenteric lymphadenitis, complication of Yersinia infection) 
Meckel's diverticulum
Diverticulitis
Inflammatory bowel disease
UTI
Gynaecological diseases