Appendicitis

Question 1

What is appendicitis?

Answer 1

Sudden inflammation of the appendix

Question 2

What is the most common cause of appendicitis?

Answer 2

Most commonly caused by an obstruction of the appendix lumen - stasis
which results in the invasion of gut organisms into the appendix wall leading to INFLAMMATION, necrosis and rupture
SURGICAL EMERGENCY

Question 3

Causes of obstruction to the appendix

Answer 3

Faecoliths (stony mass of compacted faeces)
Bezoars (partially digested material collected in the stomach)
Trauma
Intestinal worms
Lymphoid hyperplasia

Question 4

Key clinical presentation of appendicitis

Answer 4

ABDOMINAL PAIN
- starts central (umbilicus) and migrates to the right iliac fossa within the first 24 hours
- this is called MCBURNEYS POINT
- rebound tender mass w/ guarding
-fever/N/V

Inflammation irritates overlying peritoneum (peritonitis)

Question 5

What sign do you see in appendicits

Answer 5

Rosving Sign- If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant

Question 6

Investigations acute appendicitis

Answer 6

Diagnosis:

Clinical presentation
Blood tests: raised WCC (neutrophils), raised CRP & ESR (inflammation)

Abdo ultrasound - Swollen appendix

GOLD STANDARD: CT scan (highly specific and sensitive

Question 7

Management of appendicitis

Answer 7

First - IV antibiotics (metronidazole) and IV fluids
GOLD STANDARD = laparoscopic appendicectomy

Question 8

Complications of appendicitis

Answer 8

Perforation

Appendix mass: the omentum sticks to the inflamed appendix forming a mass in the RI