Appendicitis

Question 1

Causes

Answer 1

Faecolith - stony mass of compacted faeces

When appendix is obstructed, for example by fibrous tissue or a foreign body or feacolith.
Bacteria multiply and invade the appendiceal wall. Pressure necrosis occurs and perforation may ensue.

Gangrene is also a possibility owing to its vascular supply; the appendix takes its arterial supply from the appendiceal artery, an end artery of the ileocolic artery. Thus, if thrombosed gangrene and perforation quickly occur.

Question 2

Symptoms

Answer 2

PAIN: Peri-umbilical –> RIF

N&V (note usually this is once or twice, if vomiting is persistent consider obstruction)

Anorexia (very common)

Constipation (most common)/ diarrhoea (rarer)

Systemic features of infection such as a fever and tachycardia

Question 3

Signs

Answer 3

Pain on palpation over the right iliac fossa
Rovsing’s sign may be present, where palpation in the left iliac fossa produces pain on the right-hand side.
Abdomen may also be rigid/ peritonitic if perforation has occurred.

Question 4

Invx

Answer 4

Bloods
FBC White cell count, CRP
U&Es if dehydrated to check renal function
LFTs and amylase if doubt to rule out biliary differentials
clotting
G&S for theatre
blood cultures if septic

VBG – check lactate
Urine HCG in females/ exclude renal calculi differential
A urine dip may be positive for leukocytes in appendicitis

Question 5

Complications

Answer 5

Local abscess
Perforation
Gangrene