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
