Appendicitis

Question 1

At what age is appendicitis most common?

Answer 1

10-20 years

Question 2

Describe the pathogenesis of appendicitis

Answer 2

→ faecolith obstruction of appendiceal lumen
→ gut organisms invading the appendix wall
→ oedema, ischaemia +/- perforation

Question 3

Describe the location and nature of appendicitis pain

Answer 3

peri-umbilical pain which radiates then migrates to RIF

Pain worse on coughing/speed bumps

Question 4

Other than pain, what symptoms may patients present with in appendicitis?

Answer 4

• vomiting
• ?diarrhoea
• pyrexia
• anorexia/ reduced appetite

Question 5

Examination findings in appendicitis

Answer 5

• generalised peritonitis if perforation has occurred
• localised peritonism
• rebound and percussion tenderness
• guarding and rigidity
• Rovsing’s sign
• psoas sign

Question 6

Rosvings Sign

Answer 6

palpation in the LIF causes pain in the RIF

Question 7

Psoas sign

Answer 7

pain on extending hip if retrocaecal appendix

Question 8

What would the white blood cell count typically show in a patient with accute appendicitis?

Answer 8

neutrophil-predominant leucocytosis (80-90%)

Question 9

What investigations can be used to exclude other causes of abdominal pain

Answer 9

Urine dip
- exclude pregnancy, renal colic, UTI

Ultrasound
- may not show appendix, but may show free fluid in pelvis

Question 10

Thin, male patients with a high likelihood of appendicitis may be diagnosed clinically. TRUE/FALSE?

Answer 10

TRUE

Question 11

Free fluid in the pelvis on a scan is always pathological in males. TRUE/FALSE?

Answer 11

TRUE

Question 12

Management of appendicitis

Answer 12

Surgery (appendicectomy)
- laparoscopic or open

IV abx prophylactically