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Year Three - Paediatrics > Appendicitis > Flashcards

Appendicitis Flashcards

1
Q

What is appendicitis?

A

It is defined as a condition in which there is inflammation of the appendix

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2
Q

What is the most common indication for emergency paediatric surgery?

A

Appendicitis

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3
Q

What is the appendix?

A

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

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4
Q

What is the function of the appendix?

A

It acts as a reservoir for intestinal flora, which allows the gut to replenish its microbiome after gastroenteritis

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5
Q

What is the pathophysiological cause of appendicitis?

A

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

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6
Q

What is the pathophysiological consequence of appendicitis?

A

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

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7
Q

What four risk factors are associated with appendicitis?

A

Children, 10 – 20 Years Old

Male Gender

Breastfeeding < 6 Months

Smoke Exposure

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8
Q

What are the thirteen clincial features of appendicitis?

A

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

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9
Q

Describe the location of abdominal pain in appendicitis. Explain

A

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

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10
Q

What are the two exacerbations of abdominal pain in appendicitis?

A

Coughing

Speed Bumps

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11
Q

What is rebound tenderness?

A

It is defined as increased pain when quickly releasing pressure on the right iliac fossa

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12
Q

What is percussion tenderness?

A

It is defined as pain and tenderness when percussing the abdomen

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13
Q

What is McBurney’s point?

A

It is the area one third the distance from the anterior superior iliac spine (ASIS) to the umbilicus

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14
Q

What is Rovsing’s sign?

A

It is when palpation of the left iliac fossa causes pain in the right iliac fossa

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15
Q

What is the psoas stretch sign?

A

It is when extension of the right thigh, in the left lateral position, causes right iliac fossa pain

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16
Q

What is the obturator sign?

A

It is when internal rotation of the flexed right thigh causes pain

17
Q

What is a positive hop test?

A

It is when there is stimulation of pain due to hopping or jumping

18
Q

What is Murphy’s triad?

A

Low Grade Fever

Nausea & Vomiting

Right Iliac Fossa Pain

19
Q

What are the two clincial features of peritonitis in appendicitis?

A

Rebound Tenderness

Percussion Tenderness

20
Q

What is the feature of appendicits on digital rectal examination?

A

There is worsening of abdominal pain in the right side of abdomen

21
Q

What four investigations are used to diagnose appendicitis?

A

Blood Tests

Urinalysis

Ultrasound Scan

MRI Scan

22
Q

What four blood test results indicate appendicitis?

A

Increased WBC Levels

Increased Neutrophil Levels

Increased CRP Levels

Increased ESR Levels

23
Q

What are the two features of appendicitis on urinalysis?

A

Mild Leucocytosis

No Nitrites

24
Q

When are ultrasound scans used to diagnose appendicitis?

A

It is the first line imaging investigation, which is useful in young females with suspected appendicitis in order to exclude ovarian and gynaecological pathology

25
Q

What are the five features of appendicitis on ultrasound scans?

A

Non-Compressible Appendix > 6mm

Appendix Wall Thickening > 3mm

Appendicolith In Appendix

Right Iliac Fossa Free Fluid

Mesenteric Fat Echogenicity

26
Q

When are MRI scans used to diagnose appendicitis?

A

They are the second line imaging investigation used to diagnose appendicitis

27
Q

What are the two features of appendicitis on MRI scans?

A

Distended Appendix > 6mm

Appendix Wall Thickening > 3mm

28
Q

What is the most appropriate management option in suspected appendicitis?

A

Urgent secondary care admission

29
Q

What is the pharmacological management option of appendicitis?

A

IV Prophylactic Antibiotics

30
Q

How are IV prophylactic antibiotics used to manage appendicitis?

A

They are used to reduce wound infection risk, following surgical management

31
Q

What is the surgical management option of appendicitis?

A

Laparoscopic Appendicectomy

32
Q

What is the gold standard management option of appendicitis?

A

Laparoscopic Appendicectomy

33
Q

What is laparoscopic appendicectomy?

A

It involves laparoscopic removal of the appendix

34
Q

What are the four complications of laparoscopic appendicetomy?

A

Bleeding

Infection

Bowel/Bladder Injury

Venous Thromboembolism

35
Q

How does an appendix mass occur in appendicitis?

A

It occurs when the omentum surrounds and sticks to the inflamed appendix, forming a mass in the right iliac fossa

36
Q

What is the management option of appendicitis, which is associated with an appendix mass?

A

It involves supportive treatment and antibiotics – followed by delayed appendicectomy for several months once the acute inflammation has settled

37
Q

What are the three complications associated with appendicitis?

A

Appendix Abscess

Appendix Perforation

Peritonitis

Year Three - Paediatrics (29 decks)

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