Appendicitis Flashcards

1
Q

Explain the aetiology/risk factors for appendicitis.

A
  • Obstruction of the appendiceal lumen, causing a cycle of progressive inflammation and bacterial overgrowth.
  • Poor dietary fibre intake: Increased, bowel transit time, and the formation of faecaliths.
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2
Q

Summarise the epidemiology of appendicitis.

A

Most common cause of acute abdomen in children.

Incidence: 4/1000 children.

Any age, most common >5 years of age, uncommon <3 years.

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3
Q

What are the symptoms of appendicitis?

A
  • Classical presentation is when there colicky umbilcal abdominal pain which then localizes to the right iliac fossa.
  • Later the pain becomes constant with peritoneal inflammation and worsens with movement.
  • Low grade-fever, loss of appetite, lethargy, vomiting, constipation/diarrhea.
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4
Q

What are the signs of appendicits?

A

Tachycardia

Pyrexia

Reluctance to move.

Pain on expansion + recession of the abdomen.

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5
Q

What signs are found on abdo exam in appendicitis?

A
Percussion tenderness (inflammation of peritoneum)
Guarding in RIF (McBurney’s point).
Rovsing’s sign (RIF pain on palpation of LIF).
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6
Q

When is a Rectal examination indicated in appendicitis?

A

: performed by the most senior doctor only when dx is in doubt. Marked tenderness against anterior rectal wall, esp. with a retrocaecal appendix.

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7
Q

What are some investigations for appendicitis?

A

General: Appendicitis is a clinical diagnosis; investigations may aid diagnosis in difficult cases.

Bloods: FBC (normal WCC doesn’t exclude appendicitis), CRP, U&Es (especially if vomiting), clotting. Raised neutrophil count is the most sensitive serological investigation for appendicitis.

Urine: MC&S to exclude UTI, leucocytes may be present with an inflamed appendix against bladder wall (nitrite -ve).

Radiology: Plain AXR not indicated; if performed, may show dilated loops of bowel and a fluid level in the RIF. USS may show the inflamed appendix as a non-compressible tubular structure, presence of free fluid or appendiceal mass.

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8
Q

Peritoneal irritation signs may be absent with a

A

Retrocaecal appendicitis.

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9
Q

What bloods may be performed if dx is in doubt in appendicitis?

A

FBC (normal WCC doesn’t exclude appendicitis)

CRP

U+Es (esp. if vomiting)

Clotting

Raised neutrophil count is the most sensitive serological Ix for appendicitis.

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10
Q

What urine Ix may be performed if dx is in doubt in appendicitis?

A

Urine: MC&S to exclude UTI, leucocytes may be present with an inflamed appendix against bladder wall (nitrite -ve).

Radiology: Plain AXR not indicated; if performed, may show dilated loops of bowel and a fluid level in the RIF. USS may show the inflamed appendix as a non-compressible tubular structure, presence of free fluid or appendiceal mass.

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11
Q

What radiological Ix may be performed if dx is in doubt in appendicitis?

A

Plain AXR not indicated; if performed, may show dilated loops of bowel + a fluid level in the RIF.

USS may show inflamed appendix as a non-compressible tubular structure, presence of free fluid or appendiceal mass.

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12
Q

What is the management for appnedicitis?

A

Refer to paediatric surgery and seniors immediately.

Surgery Planning (“GAME”)

  • Group and cross match
    Intravenous antibiotics (cefoxitin or tazocin) – will vary according to trust guidelines.
  • MRSA screen
  • Nil by mouth (Eating and drinking)- Give intravenous fluids.

Appendectomy (open or laparoscopic): Laparoscopic is preferred in uncomplicated appendicitis. Need an extensive washout – high risk of infection and mortality in children.

If patient is unstable for surgery, they must first be optimized before they undergo surgery.

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13
Q

What are complications associated with appendicitis?

A
  • Perforation: <3 years old - 80–100%; >10 years old - 10–20%.
  • Complicated appendicitis (perforated/presence of pus)
  • Wound infection leading to intra-abdominal abscess formation.
  • Decreased fertility in girls after complicated appendicitis (ovarian/fallopian tube involvement)
  • Small bowel obstruction
  • Adhesions
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14
Q

What is the prognosis of appendicitis?

A

Excellent prognosis with tx

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