Appendicitis Flashcards
What is appendicitis?
acute inflammation of the vermiform appendix
What is the main cause of acute appendicitis?
- Obstruction of the lumen of the appendix
What are the main causes for the obstruction causing acute appendicitis?
- Faecolith (a hard mass of faecal matter),
- normal stool
- lymphoid hyperplasia are the main
What age is appendicitis most common in?
10-20 years
What are the symptoms of appendicitis?
- Acute central abdominal pain move to right lower quadrant
- Anorexia
- Nausea and vomiting
- Right lower quadrant tenderness
What are the more systemic symptoms of appendicitis?
- Low grade pyrexia
- Flushed face and a fetor
- Reduced bowel sounds
- Guarding and rebound or percussion tenderness in RIF
What score is used appendicitis?
High or intermittent risk score (AIR and AAS) – Alvarado to rule out
What signs are present in appendicitis?
- Rovsings signs
- Psoas sign
- Cope sign
What are the possible differential diagnosis with appendicitis?
- Acute mesenteric adenitis
- Viral gastroenteritis
- Meckel’s diverticulitis
- Intussusception
- Crohn’s disease
- Peptic ulcer disease
- Right-sided ureteric stone
- Cholecystitis
- Urinary tract infection
- Primary peritonitis
- Pelvic inflammatory disease
- Ruptured Graafian follicle (mittelschmerz)
- Ectopic pregnancy
- Ovarian torsion
What are some of the first things you check for in appendicitis?
- Look for signs of perforation appendix: look for sepsis
2. High suspicion in pregnant women
What first investigations do you order for appendicitis?
- FBC
- CRP
- Abdominal US
- Contrast enhanced abdominal CT
What would the fbc show in appendicitis?
mild leukocytosis (10-18 x 109/L or 10,000 to 18,000/microlitre)
What would the CRP be like in appendicitis?
elevated
What would the abdominal US show in appendicitis?
aperistaltic or non-compressible structure with outer diameter >6 mm
What would the contrast enhanced abdominal CT show in appendicitis?
- abnormal appendix (diameter >6 mm) identified
2. or calcified appendicolith seen in association with peri-appendiceal inflammation
What other investigations would you consider with appendicitis?
- Urinanalysis
- Pregnancy test
- Group and save
- Abdominal MRI
What is the first line treatment for uncomplicated appendicitis (fit for surgery)?
- supportive treatment:
- nil by mouth
- analgesia
- obstetric support is preggers - Plus: appendicectomy
What is the first line treatment for someone with uncomplicated appendicitis: unfit/does not want surgery?
- First line: supportive treatment:
- nil by mouth
- analgesia
- obstetric support is preggers - Plus: antibiotics
What is the first line treatment for someone with complicated appendicitis: with free perforation and/or acutely unwell?
- supportive treatment
- Involve critical care and seek immediate surgical input for any patient with suspected perforated appendicitis and signs of shock or sepsis
- analgesia
- obstetric support if preggers - Plus:
- Emergency appendicectomy
- Post-op antibiotics
What is the first line treatment for complicated appendicitis: stable with abscess or phlegmon?
1st line: supportive treatment -nil by mouth -analgesia -obstetrics if preggers Plus: 1. Laparoscopic appendicectomy 2. Post op antibiotics
What is the second line treatment for complicated appendicitis: stable with abscess or phlegmon?
- antibiotics and percutaneous image guided drainage
2. Consider: interval appendicectomy
What are the possible complications with appendicitis?
- Perforation
- Generalised peritonitis
- Appendicular mass
- Appendicular abscess
- Surgical wound infection
What is the prognosis of appendicitis like?
Leave 1 day after surgery is uncomplicated
What is Murphy’s triad?
- Abdo pain: umbilical to right iliac fossa
- N+V
- Low grade fever
Can symptoms vary?
Sx may be different in different groups of pts
What are symptoms like in a child?
vague pain + stop eating favourite food
What are symptoms like in elderly?
no pain, just confusion
What are symptoms like in pregnant?
N+V, local peritonitis
What is Pain at Mcburney’s point?
1/3 way from ASIS to umbilicus
What does percussion and rebound tenderness mean?
pain on percussion / removal of pressure
What is Rovsing’s sign?
palpation of the left iliac fossa causes right iliac fossa pain
What is the psoas sign?
extension of the right thigh, in the left lateral position, causes right iliac fossa pain
What is the obturator sign?
internal rotation of the flexed right thigh causes pain
