Appendicitis Flashcards
What is Appendicitis?
Inflamm of appendix
What ages does Appendicitis most commonly happen at?
10-20 yrs
What is the pathophysiology of Appendicitis? (5 steps)
- Lumen obstruction by Lymphoid Hyperplasia / Faecolith / Filarial Worm
- Pathogens get trapped bc obst @ point where appendix meets bowels
- Pathogens –> infection + inflamm
- Inflamm –> gangrene –> Appendix ruptures
- Faecal contents + infective material released into –> Peritoneal Cavity
- Peritonitis (inflamm of peritoneal lining)
What is a Faecolith?
Stony mass of compacted faeces
What are the CF of Appendicitis? (5 + 7 things)
- Periumbilical pain –> moves to RIF (within first 24 hrs)
- Fever (low grade)
- LOA (loss of appetite)
- N + V
- Conspitation (sometimes diarrhoea)
@ exam
- Rovsing’s Sign
- Psoas Sign
- Cope Sign
- Guarding
- Tenderness @ McBurney’s Point
- Rebound tenderness (perforation)
- Percussion tenderness (perforation)
What is the explanation for the shift of Periumbilical to RIF pain as Appendicitis progresses? (2 things)
- Early inflamm = irritiates structures + walls of appendix –> colicky pain referred to Periumbilical region
- Inflamm progresses = irritates parietal peritoneum (esp @ exam) –> somatic + lateralized pain @ McBurney’s Point in RIF
Where is McBurney’s Point?
1/3 of distance between Anterior Superior Iliac Spine (ASIS) and Umbilicus
What is Rovsing’s Sign? (2 things)
- Press the LIF (only)
- More pain in RIF than LIF
What is Psoas Sign?
Pain @ hip extension (if retrocaecal appendix)
Retrocaecal appendix = appendix inflammed so much it’s risen up to be behind level of caecum
What is Cope Sign? (2 things)
- Pain @ flexion + int rot of R hip
- Indicates inflamm pelvis is close contact w obturator internus muscle
What is the diagnosis of Appendicitis usually based on? (2 things)
- Clinical features
- Raised inflamm markers
(But imaging used in uncertain cases)
What investigations should you do for sus Appendicitis?
- Bloods
- CT (highest diagnostic accuracy)
- US (females / kids)
What may the bloods of a Appendicitis show? (2 things)
- Neutrophil lecuocytosis (high no. of neut)
- Elevated CRP
What is the use of a CT in sus Appendicitis? (2 things)
- Highest diagnostic accuracy (used to confirm diagnosis)
- Reduces -ve appendicectomy rate
Why would you do US on sus Appendicectomy on females?
To exclude ovarian + gynaecological pathology
Why would you do US on sus Appendicectomy on kids?
Less radiation than CT
What should you do when CF suggest Appendicitis, but investigations are negative?
Diagnostic Laparoscopy to visualise appendix directly
Can do appendicectomy str8 away if indicated
What are some DD of Appendicitis? (4 things)
- Ectopic pregnancy
- Ovarian cysts
- Meckel’s Diverticulum
- Mesenteric Adenitis
Which sus Appendicitis patients should you consider the DD of Ectopic Pregnancy for?
Why is this important?
Females of child-bearing age
Ectopic pregnancy = gynaecological EMERGENCY w high mortality if mismanaged
How do you differentiate between Appendicitis and Ectopic Pregnancy?
Serum / urine Human Chorionic Gonadotropin (hCG)
How do Ovarian Cysts present similary to Appendicitis?
Pelvic / iliac fossa pain
(Esp when rupture / torsion)
What is Mesenteric Adenitis?
Inflamed abdominal lymph nodes
How does Mesenteric Adenitis present similarly to Appendicitis?
Abdominal pain, in young children
How can you differentiate Mesenteric Adenitis from Appendicitis?
MA = often assoc w tonsillitis / URTI
What is the initial management of a patient w sus Appendicitis? (2 things)
- Emergency admission for appendicectomy surgery
- Abx
What is the definitive treatment for Appendicitis?
Appendicectomy (usually laparoscopic)
When is the Appendicectomy preffered to do LAPAROSCOPICALLY? (2 things)
- Women
- Obese
When is the Appendicectomy preferred to NOT do it laparoscopically?
Why?
Sus gangrenous perforation
Bc higher rate of abscess formation
What are the complications of an Appendicectomy? (6 things)
- Removal of normal appendix
- Damage to bowel / other organs
- Bleeding
- Infection
- Pain + Scars
- DVT / PE
What are the complications of Appendicitis? (3 things)
- Perforation (13-20% of cases)
- Appendix Mass
- Appendix Abscess
When is Perforation more commonly seen as a complication of Appendicitis?
Why?
- When Faecolith present
- Young children
Bc diagnosis often delayed
How can Appendix Masses occur as a complication of Appendicitis?
When Appendix becomes covered with omentum
How is an Appendix Mass (complication of Appendicitis) diagnosed?
US / CT
How should you manage an Appendix Mass (complication of appendicitis)? (3 points)
- Early surgery
OR
- Conservatively: NBM / Abx
- If resolved, can do delayed Appendicectomy
What should you exclude when you sus Appendix Mass (complication of Appendicitis)?
How will you exclude it?
Colonic tumour (presents early as 40 yrs old)
Laparotomy or Colonoscopy
How can an Appendix Abscess occur as a complication of Appendicitis? (2 points)
- Appendix Mass fails to resolve –> enlarges
- Patient becomes more unwell
What is the treatment for an Appendix Abscess (complication of Appendicitis)? (2 things)
- Drainage (surgical / percutaenous under CT/US guidance)
- Abx (could resolve it alone)
