appendicitis

Question 1

what is the name of the scoring system used to predict the likelihood of appendicitis and what does it consist of?

Answer 1

• Alvadro score
• score >7 suggests appendicitis
• 5-6 may warrant an USS or CT

features:

• migratory pain to RIF
• anorexia
• nausea and vomiting
• right iliac fossa tenderness
• rebound tenderness
• fever
• high white cell count
• leukocyte left shift >75% neutrophils

Question 2

which primary investigations should you do for an appendicitis?

Answer 2

FBC: leukocytosis and neutrophilia is seen in up to 90% of patients

CRP: raised due to inflammation

U&Es: acute kidney injury in dehydration secondary to vomiting, or in instances of perforation and sepsis

Group & save: important to conduct prior to surgical intervention

Urinalysis: perform in all patients to exclude renal colic, a urinary tract infection or pregnancy in women; in appendicitis, there may be a mild leukocytosis without nitrites

Question 3

which imaging investigations should be considered when suspecting an appendicitis?

Answer 3

• CT abdo pelvis is first line for appendicitis
• abdominal USS preferred in pregnant
  women and children. will show a non compressible inflamed appendix
• MRI for pregnant women when USS is not diagnostic

Question 4

what is the initial management for an appendicitis?

Answer 4

Fluids: patients will require hydration due to fluid losses, as well as due to being nil-by-mouth prior to surgery

Analgesia: patients can be in considerable pain

Antiemetics: can be given for nausea and vomiting e.g. ondansetron

Preoperative IV antibiotics: prophylactic antibiotics are associated with reduced wound infection rates, e.g. ceftriaxone and metronidazole

Question 5

what are the different examination signs which may be present in an acute appendicitis?

Answer 5

• RIF tenderness- rebound tenderness suggests perotinitic
• rovings sign-> pain in RIF is worse when pressing on LIF
• PSOAS sign- pain worse when extending the hip
• obturator sign-> pain worse when flex and internally rotate hip

tachycardia, hypotension and general guarding may suggest perforation

• low grade fever

Question 6

what is the cause of appendicitis?

Answer 6

• luminal obstruction of appendix by…

1. faecolith
2. foreign body
3. lymphoid hyperplasia of peters patch
4. fibrous stricture

Question 7

what are risk factors for appendicitis?

Answer 7

Young age: the highest incidence is between 10-20 years of age
Male
Frequent antibiotic use: causes an imbalance in gut flora and a modified response to subsequent infection which may trigger appendicitis
Smoking

Question 8

what is the definitive management for appendicitis?

Answer 8

• prompt lap apendicectomy
• abdominal lavage for perforated appendicitis
• antibiotics given for 24hrs after

Question 9

what are complications of appendicitis?

Answer 9

Perforation (15-20%): if left untreated, there is a significant risk of appendiceal rupture, which will lead to sepsis and death if untreated

Appendiceal mass: a walled-off perforated appendix may form a mass in the right iliac fossa; for patients with an appendix mass without peritonitis, broad-spectrum antibiotics are usually offered with consideration of an interval appendicectomy

Abscess: inflammation may cause the formation of a localised collection of pus in proximity to the appendix, which will require drainage