Appendicitis

Question 1

What is appendicitis and what is the peak incidence of appendicitis?

Answer 1

Inflammation of the appendix. Peak incidence of appendicitis is in patients aged 10 to 20 years

Question 2

1) What leads to the infection and inflammation seen in appendicitis?
2) What are the 2 things that infection can proceed to?
3) How can this result in peritonitis?

Answer 2

1) Pathogens can get trapped due to obstruction at the point where the appendix meets the bowel, leading to inflammation and infection
2) Gangrene and rupture
3) When the appendix ruptures, faecal contents and infective material are released into the peritoneal cavity, leading to peritonitis

Question 3

1) Where does the abdominal pain in appendicitis usually start?
2) Where does the abdominal pain in appendicitis usually migrate to?
3) Name 3 other signs/symptoms of appendicitis
4) What is Rovsing’s sign?
5) What is psoas’ sign?

Answer 3

1) Periumbilical pain (central abdominal pain)
2) Right iliac fossa
3) Loss of appetite, nausea and vomiting, low-grade fever, Rovsing’s sign, guarding on abdominal palpation, rebound tenderness in the RIF, percussion tenderness
4) Palpation of the left iliac fossa causes pain in the RIF
5) If appendix is located posterior to colon, it may irritate the psoas - this is made better by hip flexion, and worse by extension

Question 4

Which 2 of the signs and symptoms of appendicitis suggests peritonitis?

Answer 4

Rebound tenderness and percussion tenderness

Question 5

1) What 2 things is a diagnosis of appendicitis usually based on?
2) Name an investigation that can confirm the diagnosis

Answer 5

1) Raised inflammatory markers, clinical presentation
2) Ultrasound, CT, diagnostic laparoscopy

Question 6

Name 2 differential diagnosis of appendicitis

Answer 6

• Ovarian cyst
• Meckel’s diverticulum
• Mesenteric adenitis
• Ectopic pregnancy

Question 7

How is appendicitis managed?

Answer 7

Removal of the inflamed appendix - laparoscopic appendectomy

Question 8

Name 2 complications of appendicitis

Answer 8

• Perforation
• Appendix mass
• Appendix abscess
• Complications of the surgery

Question 9

What should be done prior to an appendectomy?

Answer 9

Prophylactic IV antibiotics