Appendicitis

Question 1

Explain the pathophysiology of appendicitis?

Answer 1

Pathogens become tapped due to obstruction. This leads to infection and inflammation which may proceed to gangrene and rupture. Rupture causing faecal matter and infection to leak into peritoneal cavity which causes peritonitis

Question 2

What are the signs and symptoms of appendicitis?

Answer 2

Starts - Central abdo pain which moves to right iliac fossa in first 24h.
Tenderness at McBurney’s point (1/3rd way between ASIS and umbilicus).
Pain worse on coughing or going over speed bumps.
Nausea and vomiting,
Fever,
Anorexia is very common
Guarding,
Rebound tenderness
Percussion tenderness.

Question 3

How is the diagnosis of appendicitis made?

Answer 3

Clinical presentation and raised inflammatory markers - neutrophil predominant leucocytosis seen in 80-90%.

Ultrasound to exclude ovarian pathology. Gold standard is CT although it is second line to ultrasound due to radiation.
Erect chest X ray to exclude pneumoperitonitis
Diagnostic laparoscopy

Question 4

What are the key differentials of appendicitis?

Answer 4

• Ectopic pregnancy,
• Ovarian cysts
• Meckel’s diverticulum which can cause a volvulus/intussuception
• Mesenteric adenitis (inflamed abdominal lymph nodes)
• Appendix mass - Occurs when omentum which surrounds the appendix becaomes inflammed

Question 5

What is the management of appendicitis?

Answer 5

Laparoscopic appendicectomy
Prophylactic antibiotics
Open appendicectomy

Question 6

What are the complications of an appendicectomy?

Answer 6

Bleeding/infection/pain,
Damage to bowel/bladder
Anesthetics risk
VTE

Question 7

Classical signs in appendicitis?

Answer 7

Rovsing’s sign - palpation in LIF causes pain in RIF. Limited value.
Psoas sign - Pain on extending hip if retrocaecal appendix.