Appendicitis

Question 1

What is Appendicitis?

Answer 1

• Appendicitis is inflammation of the appendix
• The appendix is a small, thin tube coming from the caecum
• The appendix becomes inflamed due to infection caused by an obstruction
• This inflammation can lead to gangrene and rupture
• The faecal and infective material released into the abdomen after the rupture can lead to peritonitis, which is the inflammation of the peritoneal contents

Question 2

What are the signs and symptoms of Appendicitis?

Answer 2

• Abdominal Pain (central), moves down to the RIF
• Tenderness in McBurney’s point
• Loss of appetite
• Nausea and Vomiting
• Guarding on abdominal palpation
• Rebound tenderness
• Percussion tenderness

Question 3

Where is McBurney’s point?

Answer 3

• 1/3 the distance from the ASIS to the umbilicus

Question 4

What is Rovsing’s sign?

Answer 4

• Palpation of the LIF causes pain in the RIF

Question 5

What is Rebound tenderness?

Answer 5

• Increased pain when quickly releasing pressure on the RIF

Question 6

What are two signs of peritonitis?

Answer 6

• Rebound tenderness and percussion tenderness

Question 7

How do you make a diagnosis of Appendicitis?

Answer 7

• Clinical presentation and raised Inflammatory markers
• CT Abdo/pelvis
• USS abdo/pelvis - used in female patients to exclude ovarian and gynaecological pathology
• Diagnostic laparoscopy - to visualise the appendix directly when there is a clinical presentation of appendicitis but investigations are negative

Question 8

What are key differential diagnoses of appendicitis?

Answer 8

-Ectopic pregnancy - serum/ urine bHCG to exclude pregnancy is essential
- Ovarian Cysts - pelvic and iliac fossa pain
- Meckel’s Diverticulum - malformation of the distal ileum, normally asymptomatic can bleed and become inflamed causing a volvulus or intussusception
- Mesenteric Adenitis - inflamed abdominal lymph nodes, presents with abdominal pain. Associated with tonsillitis or URTI
- Appendix Mass - when the omentum surrounds and sticks to the inflamed appendix forming a mass in the RIF. Typically managed conservatively with supportive treatment and abx, followed by an appendicectomy once the acute condition has resolved.

Question 9

What is the managment for Appendicitis?

Answer 9

• Emergency admission
• Removal of the inflamed appendix (appendicectomy)
• Laparoscopic surgery is associated with fewer risks and faster recovery compared to open surgery (laparotomy)

Question 10

What are the complications of Appendicectomy?

Answer 10

• Bleeding, infection, pain and scars
• Damage to bowel, bladder and other organs
• Removal of a normal appendix
• Anaesthetic risks
• VTE (DVT/ PE)