Appendicitis

Question 1

What is appendicitis and what causes it?

Answer 1

Acute inflammation of the vermiform appendix, most likely due to obstruction of the lumen of the appendix.

Question 2

What is the most common cause of abdominal surgery?

Answer 2

Appendicitis

Question 3

What is this a presentation of?
10-20 years old, periumbilical pain that moves to
RIF McBurney’s point tender, anorexia, nausea, pain in RIF when palpating left, psoas sign.

Answer 3

Appendicitis

Question 4

What is McBurney’s sign found in and how is it elicited?

Answer 4

1. Appendicitis

2. Tenderness over McBurney’s point - 1/3 from ASIS to umbilicus.

Question 5

What is Rovsing’s sign found in and how is it elicited?

Answer 5

1. Appendicitis

2. Palpating in LIF causes tenderness in RIF, palpating in RIF does not cause tenderness in LIF.

Question 6

How is suspected appendicitis investigated?

Answer 6

1. High WCC + CRP plus clinical history enough for diagnosis.
2. If findings are equivocal - USS 1st line then CT may be needed, MRI in early pregnancy.

Question 7

What are the important differentials to rule out in suspected appendicitis?

Answer 7

1. Ectopic pregnancy - urinary bhCG test
2. UTI - urinalysis
3. Mesenteric adenitis - very high temperature, URTI
4. Gastroenteritis, Meckel’s diverticulum, Crohn’s

Question 8

What is the management for appendicitis?

Answer 8

1. NBM, IV fluids
2. Appendectomy without delay (laparoscopic preferred, laparotomy if perforated/pregnant.
3. IV antibiotics - Tazocin pre-op 1 dose, 2 doses post-op

Question 9

What are the complications of appendicitis?

Answer 9

1. Perforation
2. Appendix mass
3. Appendix abscess