Appendicitis

Question 1

what post- op complication is common in appedicitis with gangrenous or gas necrosis

Answer 1

collection

Question 2

what is a collection (post GI surgery)

Answer 2

occurs when some of the bowel content isn’t removed when cleaning out the peritoneum
febrile, vague abdominal pain and nausea

Question 3

what are symptoms of appendicitis

Answer 3

abdominal pain
anorexia
N&V
low grade fever

Question 4

describe the pain felt from appendicitis

Answer 4

starts central and vague
within 24 hours progresses to sharp RIF pain
due to the swelling of the appendix so it comes into contact with the peritoneal lining which has somatic innervation

Question 5

where is Mc Burneys point?

Answer 5

a third of the distance between ASIS and the umbillicus

Question 6

what is the significance of guarding in appendicitis

Answer 6

linked with perforation

Question 7

what is the significance of rebound tenderness and percussion pain

Answer 7

suggests peritonitis
may indicate perforation of appendix or other structures

Question 8

what are the two signs that you may see on examination of someone with appendicitis

Answer 8

rovsings: RIF on palpation of the LIF

psoas sign: RIF on extension of right hip
more sensitive for retroperitoneal appendix

Question 9

what investigations would you want to do when suspicious of appendicitis

Answer 9

can be diagnosed on clinical examination and raised inflammatory markers

Us&Es if they’ve been vommiting, group and save

could CT or USS

Question 10

when would a CT be inappropriate for investigating suspected appendicitis

Answer 10

clinically unstable
concerned about ovarian causes
children

Question 11

if someone has clinical presentation of appendicitis but negative findings what could you do

Answer 11

diagnostic laparoscopy

Question 12

what is an appendix mass

Answer 12

when the omentum adheres to the inflamed appendix causing a mass in the RIF

Question 13

how are appendix masses managed

Answer 13

conservative treatment only till resolved
can use supportive treatment and ABX
once resolved (around 6 weeks) appendicectomy

Question 14

how do you manage appendicitis

Answer 14

emergency admission under surgical team
laparoscopic appendectomy with routine exploration of the abdomen
don’t give pre-operative ABX if they are going to have surgery within 12 hour of presentation