Apendicitis

Question 1

What is appendicitis?

Answer 1

Occurs when the lumen of the appendix becomes obstructed by a faecolith (impacted faeces)

Causing inflammation

Question 2

Describe the pathology of appendicitis?

Answer 2

Gut organsims invade the appendix wall after luminal obstruction by:
Lymphoid hyperplasia, faecolith, filarial worms

Leads to oedema, ischaemic necrosis and perforation

Impaired ability to prevent invasion may be due to hygiene hypothesis

Question 3

Epidemiology of appendicitis

Answer 3

Most common surgical emergency
Highest incidence is 10-20yrs
Rare in very young and very old

Question 4

Symptoms of appendicitis?

Answer 4

Classically: periumbilical pain that moves to right iliac fossa

Anorexia,
Constipation

Question 5

General clinical signs of appendicitis

Answer 5

Tachycardia,
Fever
Furred tongue
Coughing hurts
Foetor (foul smell)

Question 6

RIF signs of appendicitis

Answer 6

Guarding
Rebound + percussion tenderness
PR painful on right

Question 7

Differential diagnosis of appendicitis

Answer 7

Non specific mesenteric lymphadenitis 
Terminal ileitis due to Crohn’s disease
Yersinia infection 
Acute salpingitis (fallopian tube) in women
Inflamed Merckel’s diverticulum
Functional bowel disease

Question 8

Diagnostic tests and results

Answer 8

Rovsing’s sign- greater pain in RIF than LIF when LIF is pressed

Psoas sign- pain on flexing the hip

Cope sign- pain on flexion and internal rotation of right hip

Blood tests- neutrophil leucocytosis

Question 9

Treatment for appendicitis

Answer 9

Prompt appendectomy

Pre-op Abx- metronidazole, ceforozime IV

Question 10

Appendicitis complications

Answer 10

Perforation
Appendix mass
Appendix abscess