Acute appendicitis Flashcards
what is appendicitis?
inflammation of the appendix
what is the cause of appendicitis?
direct luminal obstruction
often a faecolith or lymphoid hyperplasia
rarely appendiceal or caecal tumour
what are the risk factors for appendicitis?
FHx - genetics 30% of risk
Ethnicity - more common in caucasians, ethnic minorities at more risk of perforation if they do get it
environmental - seasonal presentation in summer
how does appendicitis present? (clinical features)
abdominal pain - peri-umbilical initially, dull and poorly localised, migrated to RIF, well localised and sharp
vomiting, anorexia, nausea, diarrhoea, constipation ,
what is seen on examination of a patient with appendicitis?
tachycardic tachypnoeic pyrexial rebound tenderness percussion pain over McBurney's point potential guarding (if perforated)
where is McBurney’s point?
2 thirds of the way between the umbilicus and the ASIS
what are the 2 specific signs seen on examination?
Rovsing’s sign: RIF pain on palpation of the LIF
Psoas sign: RIF pain with extension of right hip (inflamed appendix abutting psoas major muscle in a retrocaecal position)
DDx for appendicitis
ectopic pregnancy ovarian cyst rupture PID ureteric stone UTI pyelonephritis mesenteric adenitis diverticular disease IBD meckel's diverticulum testicular torsion epididymo-orchitis
what investigations should be done in suspected appendiciits?
urinalysis - renal/urological cause and pregnancy
routine bloods - FBC and CRP to asses raised inflammatory markers as well as potential pre op bloods
what imaging is used to investigate appendicitis?
not essential for diagnosis
USS - first line (transvaginal if gynaecological pathology in DDx)
CT - good sensitivity and specificity, good to assess other gi and urological DDx
how is appendicitis managed?
definitive treatment - laparoscopic appendicectomy
appendix should be sent to histopathology to look for malignancy (1%)
entire abdomen is inspected
sometimes is converted into open
complications of appendicitis
perforation - untreated can rupture and contaminate peritoneum
surgical site infection
appendix mass - where omentum and small bowel adhere to appendix
pelvic abscess - fever and palpable RIF mass, conformed by CT (Abx and drainage)
what age group usually develop appendicitis?
20-30 year old
