Appendicitis

Question 1

What causes acute appendicitis?

Answer 1

Obstruction of the opening of the appendix causing inflammation:

• faecolith (hardened stool)
• lymphoid hyperplasia
• filarial worms

Question 2

How would someone with acute appendicitis present?

Answer 2

Central periumbilical pain which left migrates to RIF after 1st few hours 
Tachycardia 
Fever 
Peritonism w/ guarding 
Rebound tenderness in RIF 
Nausea + vomiting 
Anorexia 
Occasional diarrhoea 
Rovsings sign i.e RIF pain > LIF pain when LIF palpated

Question 3

What investigations can be done if someone suspected of appendicitis?

Answer 3

Examination= guarding + Rovsings sign
Blood tests= can show indications of inflammation i.e. neutrophil leucocytosis = raised WCC/ESR/CRP
CT scan= more sensitive and specific way to diagnose

Question 4

How is appendicitis managed?

Answer 4

Analgesia
Fluids
Appendicectomy
IV Antibiotics

Question 5

What are possible complications of appendicitis?

Answer 5

Appendix mass:
Inflamed appendix is covered and become adhered to the omentum

Appendix abscess:
Appendicular mass fails to resolve and autolysis and necrosis of the inflamed appendix occurs leading to collection of pus forming
I.e. needs to be drained

Question 6

Why does SIRS occur with appendicitis and what signs would patient present with?

Answer 6

Inflammatory mediators induce systemic inflammatory response syndrome

Raised temp, HR and fall in BP

Question 7

Why is it important to give fluids in appendicitis?

Answer 7

Increased body temp leads to increase loss
Increase metabolic rate leads to increased requirement
Oedematous state leads to sequestration of fluids

Question 8

What disease progression accounts for the typical migratory pain seen in appendicitis?

Answer 8

Appendix is midgut structure meaning visceral pain presents as central abdo pain

Irritation of parietal lining of peritoneum leads to localised RIF pain due to parietal lining having somatic nerve fibres