Appendecitis Flashcards
1
Q
ESSENCE
A
Inflammation of appendix
2
Q
EPIDEMIOLOGY
Age
A
Peaks aged 10-20, but can occur at any age
3
Q
AETIOLOGY
Pathophysiology
A
- Appendix is amll tube arising from caecum, located where three teniae coli meet (longitudinal muscles that run length of large intestine)
- Pathogens can get trapped due to obstruction, leading to infection and inflammation
- Can proceed to gangrene and rupture, where faecal and infective contents are released into peritoneal cavity causing peritonitis
4
Q
AETIOLOGY
Main cause
A
- Obstruction of lumen of appendix
- Faecolith (hard mass faecal matter)
- Normal stool
- Lymphoid hyperplasia
5
Q
CLINICAL FEATURES
Presentation
A
- Key feature is abdominal pain
- Starts central then moves to right iliac fossa within 24 hours
- Tenderness at McBurnerys point (one third distance from anterior superior iliac spine to umbillicus)
- Loss of appetite
- Nausea and vomiting
- Low grade fever
6
Q
CLINICAL FEATURES
Signs
A
- Rovings sign (palpation of left iliac fossa causes pain in right)
- Guarding on abdominal palpation
- Rebound tenderness in right iliac fossa (increased pain when suddenly releasing pressure of deep palpation)
- Percussion tenderness (pain and tenderness when percussing abdomen)
7
Q
What features of examination suggests ruptured appendix (peritonitis)
A
Rebound tenderness and percussion tenderness
8
Q
INVESTIGATIONS
First choice
A
- Diagnosis based on clinical presentation and raised inflammatory markers
- CT can be used to confirm
- US often in female patients to exclude ovarian and gynae pathology
- If investigations negative next step is diagnostic laparoscopy
9
Q
Key differentials
A
- Ectopic pregnancy
- Ovarian cysts
- Meckels diverticulum
- Mesenteric adenitis
10
Q
COMPLICATIONS
A
- Perforation
- Peritonitis
- Appendicular mass
- Appendicular abscess
11
Q
MANAGEMENT
General principles
A
- Emergency admission to hospital under surgical team
- Appendicectomy is definitive management
