Appendicitis Flashcards
What is appendicitis?
It is defined as a condition in which there is inflammation of the appendix
What is the most common indication for emergency paediatric surgery?
Appendicitis
What is the appendix?
It is an intraperitoneal hollow outpouching of the gut, which arises from the caecum
It is suspended by the mesoappendix, from the terminal portion of the ileum and commonly situates retrocaecally
What is the function of the appendix?
It acts as a reservoir for intestinal flora, which allows the gut to replenish its microbiome after gastroenteritis
What is the pathophysiological cause of appendicitis?
It is secondary to infection trapped within the appendix
This is due to obstruction at the appendiceal lumen, in which the the appendix meets the bowel, as a result of hardened stool or lymphoid hyperplasia
What is the pathophysiological consequence of appendicitis?
The inflammation can proceed to gangrene, in which there is a loss of blood supply to the appendix tissue, and rupture
Resultingly, faecal content and infective material is released into the abdomen – leading to peritonitis
What four risk factors are associated with appendicitis?
Children, 10 – 20 Years Old
Male Gender
Breastfeeding < 6 Months
Smoke Exposure
What are the thirteen clincial features of appendicitis?
Low Grade Fever
Nausea & Vomiting
Abdominal Pain
Abdominal Guarding
Rebound Tenderness
Percussion Tenderness
McBurney’s Point Tenderness
Rovsing’s Sign
Psoas Stretch Sign
Obturator Sign
Hop Test Positive
Murphy’s Triad
Anorexia
Describe the location of abdominal pain in appendicitis. Explain
It is initially located in the umbilicus – due to stimulation of visceral afferent pain nerves, which correspond to the T10 dermatome
Overtime, as the appendix becomes more inflamed, pain becomes localised in the right iliac fossa – due to irritation of the parietal peritoneum activating somatic nerve fibres
What are the two exacerbations of abdominal pain in appendicitis?
Coughing
Speed Bumps
What is rebound tenderness?
It is defined as increased pain when quickly releasing pressure on the right iliac fossa
What is percussion tenderness?
It is defined as pain and tenderness when percussing the abdomen
What is McBurney’s point?
It is the area one third the distance from the anterior superior iliac spine (ASIS) to the umbilicus
What is Rovsing’s sign?
It is when palpation of the left iliac fossa causes pain in the right iliac fossa
What is the psoas stretch sign?
It is when extension of the right thigh, in the left lateral position, causes right iliac fossa pain
What is the obturator sign?
It is when internal rotation of the flexed right thigh causes pain
What is a positive hop test?
It is when there is stimulation of pain due to hopping or jumping
What is Murphy’s triad?
Low Grade Fever
Nausea & Vomiting
Right Iliac Fossa Pain
What are the two clincial features of peritonitis in appendicitis?
Rebound Tenderness
Percussion Tenderness
What is the feature of appendicits on digital rectal examination?
There is worsening of abdominal pain in the right side of abdomen
What four investigations are used to diagnose appendicitis?
Blood Tests
Urinalysis
Ultrasound Scan
MRI Scan
What four blood test results indicate appendicitis?
Increased WBC Levels
Increased Neutrophil Levels
Increased CRP Levels
Increased ESR Levels
What are the two features of appendicitis on urinalysis?
Mild Leucocytosis
No Nitrites
When are ultrasound scans used to diagnose appendicitis?
It is the first line imaging investigation, which is useful in young females with suspected appendicitis in order to exclude ovarian and gynaecological pathology
What are the five features of appendicitis on ultrasound scans?
Non-Compressible Appendix > 6mm
Appendix Wall Thickening > 3mm
Appendicolith In Appendix
Right Iliac Fossa Free Fluid
Mesenteric Fat Echogenicity
When are MRI scans used to diagnose appendicitis?
They are the second line imaging investigation used to diagnose appendicitis
What are the two features of appendicitis on MRI scans?
Distended Appendix > 6mm
Appendix Wall Thickening > 3mm
What is the most appropriate management option in suspected appendicitis?
Urgent secondary care admission
What is the pharmacological management option of appendicitis?
IV Prophylactic Antibiotics
How are IV prophylactic antibiotics used to manage appendicitis?
They are used to reduce wound infection risk, following surgical management
What is the surgical management option of appendicitis?
Laparoscopic Appendicectomy
What is the gold standard management option of appendicitis?
Laparoscopic Appendicectomy
What is laparoscopic appendicectomy?
It involves laparoscopic removal of the appendix
What are the four complications of laparoscopic appendicetomy?
Bleeding
Infection
Bowel/Bladder Injury
Venous Thromboembolism
How does an appendix mass occur in appendicitis?
It occurs when the omentum surrounds and sticks to the inflamed appendix, forming a mass in the right iliac fossa
What is the management option of appendicitis, which is associated with an appendix mass?
It involves supportive treatment and antibiotics – followed by delayed appendicectomy for several months once the acute inflammation has settled
What are the three complications associated with appendicitis?
Appendix Abscess
Appendix Perforation
Peritonitis
