Appendicitis

Question 1

Clinical features

Answer 1

Initially periumbilical abd pain that moves to RIF
Low grade fever which may rise if there’s perforation
Nausea and vomiting

Depending on bladder position may also complain of :
Pelvic: urinary symptoms due to bladder irritation
Retroileal: constipation diarrhea tenesmus

With perforation there may be temporary relief of symptoms or even pain stops completely as tension of distended organ relieved then peritonitis develops

Question 2

What is mcburney sign

Answer 2

Maximal pain at a point 1/3 imaginary line drawn from asis to umbilicus

Question 3

What is the name of the sign given to tenderness in right iliac fossa on Palpation of the left iliac fossa

Answer 3

Rovsing sign

Question 4

What is iliopsoas sign

Answer 4

Rlq pain on passive hyper extension of the hip or flexion of right hip against resistance

Due to appendix rest on course of right psoas muscle

Question 5

What sign refers to rlq pain on internal and external rotation of right hip

Answer 5

Obturator sign

Question 6

Antibiotic prophylaxis for appendicitis

Answer 6

Given pre op

Metronidazole preferred

Can also use clindamycin or fluoroquinolones or augmentin

Gentamicin not used as much due to risk of ototoxicity snd nephrotoxicity

Question 7

Criteria for non operative management of appendicitis

Answer 7

Ct scan showing no fecolith

No evidence of peritonitis

Question 8

How does on treat an phlegmonous mass

Answer 8

NOT SURGERY

I’d operate run the risk of spreading Pus and causing generalised peritonitis