Appendicitis Flashcards
Define appendicitis
Acute inflammation of the vermiform appendix
What is the aetiology of appendicitis
Obstruction of the lumen of the appendix is the main cause of acute appendicitis
Faecolith (hard mass of faecal matter), normal stool, or lymphoid
What are the risk factors for appendicitis
Teenage
Low dietary fibre
Improved personal hygiene
Smoking
What are the symptoms of appendicitis
Abdominal pain
- Umbilical region to RIF (1-12hrs later)
- Acute onset
- Constant with intermittent cramps (colicky pain)
- Worse on movement and coughing
Anorexia
Nausea and vomiting
Fever
Loose stool (low volume, not usually offensive) OR Constipation
Collapse and generalised peritonitis
What do the sites of pain in appendicitis indicate
Flank or back: retrocaecal appendix
Testicular pain: retroileal/pre-ileal appendix
Suprapubic pain: pelvic appendix
What are the differentials for appendicitis
Ovarian torsion
Ectopic pregnancy
Mesenteric adenitis
Intussusception
Meckel’s diverticulitis
Mittelschmerz
PID
What are the signs of appendicitis on examination
General and obs
- Hypotension and tachycardia
- Low-grade pyrexia
- Flushed face and a fetor
- Patient staying still -> peritonitis (due to rupture)
Abdominal
- Tense, rigid abdomen
- Right lower quadrant tenderness, rebound tenderness
- Palpable mass
- Reduced bowel sounds
- Rovsing’s sign: Pain in the RIF when the LIF is palpated
- Cope’s sign: Pain on passive flexion and internal rotation of the hip
- Psoas sign: Pain on extending the hip (patient lies on side)*
What investigations should be done for appendicits
Bedside: urinalysis and dipstick, pregnancy test (childbearing age)
Blood: FBC(↑WCC), CRP (↑), G&S, U&Es
Other:
- US abdomen (Aperistaltic or non-compressible structure with outer diameter >6 mm)
- AXR (faecolith)
- CT abdomen (Abnormal appendix, diameter >6mm, or calcified appendix. Appendicolith seen in association with peri-appendiceal inflammation)
What is the management for uncomplicated appendicitis
- A-E assessment
- Call the surgical on-call team
- supportive treatment (AGAME)
- Analgesia e.g. paracetamol, diclofenac, morphine
- G&S
- Antibiotics (see below)
- MRSA screen
- Eating and drinking - make NBM + NG feeds
No signs of sepsis → IV Abx co-amoxiclav
What are the complications of appendicitis
Perforation (more common with faecolith i.e. in children)
Generalised peritonitis
Appendicular mass
Appendicular abscess
What is the prognosis for appendicitis
If treated, prognosis is good
Wound infection and intra-abdominal abscess are potential complications associated with appendicectomy
Laparopscopic appendicectomy has been shown to decrease the incidence of overall complications
