Appendicitis Flashcards
What is the pathophysiology behind appendicitis?
The lumen of the appendix becomes obstructed by things such as - Faecoliths (hard collection of stool) - Lymphoid hyperplasia - Fibrous stricture - Carcinoid tumour Obstruction causes stasis and bacterial over growth. This causes an increase in pressure with the appendix, causing venous and lymphatic congestion As pressure increases arterial supply is compromised so gangrene, perforation and generalised peritonitis can occur
What are the signs and symptoms of Appendicitis
colicky, peri-umbilical pain which migrates to the right iliac fossa (RIF) and becomes constant. Symptoms Classical migratory abdominal pain RIF pain Nausea Anorexia Constipation Signs RIF tenderness Percussion tenderness Localised guarding Tachycardia Pyrexia
Which obstructions can cause appendicitis
faecoliths- most common (hard collection of stool which blocks appendiceal lumen) lymphoid hyperplasia fibrous stricture carcinoid tumours
At which age range is appendicitis most common?
It is uncommon at extreme at extreme ages - the very old (largen lumen of appendix) and the very young But can occur at any age Usually 10-20 years
How would appendicitis present in a pregnant woman and why?
It will present as flank pain This is because the appendix is displaced in pregnancy
Describe the specific signs associated with appendicitis
Rovsing sign - pain in the RIF on palpation of the LIF Psoas sign: the patient lies on their left side with knees flexed, positive when there is pain in the RIF on passive extension of the right hip. ( retrocaecal appendix) Obturator sign: pain in the RIF on passive internal rotation of a flexed right hip ( appendix in close relation to obturator internus)
Which investigations are conducted to investigate appendicitis?
FBC- elevated WBC especially neutrophils U and E’s LFT’s Amylase Group and save (risk of perforation) Clotting screen CRP - elevated Pregnancy test Imaging - Ultrasound - May not always identify appendix - operator dependant CT - High diagnostic accuracy
Which score is used to assess the likely hood appendicitis?
Alvarado score 1-4 = unlikely 5-6 possible >7 likely M - Migratory pain A - Anorexia N - Neusea/ Vomiting T - Tenderness in RIF (2 points) R - Reound tenderness E - Fever >37.3 L - Leucocytosis (2 point) S - Neutrophils shift (to the left)
How is appendicitis managed?
Uncomplicated - Antibiotics (Augmentin) But may require surgery within a year Surgical - Most patients obtain laparoscopic appendicectomy (may need to be converted to open surgry) Pre-operatively start antibiotics - co-amoxiclav if no penicillin allergy. Continued for 7 days if co-amoxiclav noticed in operation
What is an appendiceal mass treated and how is it treated?
a collection of pus and stuck bowel - Surgery is likely to be complicated by inflammation and adhesions simple localised cases may be treated with antibiotics alone. If the mass resolves may perform a delayed appendectomy Larger abscesses - when an appendix mass fails to resolve but enlarges and the patient gets more unwell - percutaneous drain and antibiotics complicated loculated disease - Surgery
What are the complications of appendicitis?
Perforation - risk increases with time Appendix mass - inflamed appendix becomes covered with omentum Appendix abscess
What are the variations in which appendicitis can present?
Inflammation in a retrocecal/retroperitoneal appendix (2.5%) may cause flank or RUQ pain; its only sign may be tenderness on the right on PR. The child with vague abdominal pain who will not eat their favourite food. The shocked, confused octogenarian who is not in pain
