appendicitis Flashcards
Definition and aetiology
DEFINITION: acute inflammation of the appendix
Aetiology
- Infection secondary to obstruction of the lumen of the appendix
- The main causes of obstruction are faecolith, normal stool, lymphoid hyperplasia
Feacolith more common in pre-school children (see on AXR) and perforation more common
Obstruction leads to increased intraluminal pressure and bacterial overgrowth, ischaemia, and necrosis of the appendix
Symptoms and signs
It is very uncommon in children < 3 years
Symptoms of acute appendicitis:
* Anorexia
* Vomiting
* Abdominal pain (initially central and colicky (appendicular midgut colic), but then localising to the RIF (from localised peritoneal inflammation))
* Generalised abdominal pain (as it may present atypically in younger children)
Signs of acute appendicitis:
- Low-grade fever
- Abdominal pain aggravated by movement e.g. walking, coughing, jumping
- Persistent tenderness with guarding in the RIF (McBurney’s point)
NOTE: with a retrocaecal appendix, localised guarding may be ABSENT
In a pelvic appendix, there may be FEW abdominal signs
IMPORTANT: perforation can occur rapidly in children because their omentum is less well developed and fails to surround the appendix
Management
SURGICAL EMERGENCY: A to E approach
The patient should be nil-by-mouth from the time of diagnosis
IV fluids should be started
Group and save
Requires immediate hospital admission and frequent monitoring
Treatment of choice is an appendicectomy (laparoscopic or laparotomy)
In Complicated Appendicitis e.g. with perforation, abscess, appendix mass present:
* If there is generalised guarding consistent with perforation- fluid resuscitation and IV antibiotics are given prior to laparotomy.
* If symptoms PROGRESS- laparotomy is indicated
Complications
Complications
- Complicated appendicitis- ischaemia and necrosis which can lead to perforation and peritonitis
- Sepsis
- Death
Prognosis
* Appendicitis can resolve spontaneously but complications more likely without removal
