appendicitis

Question 1

presentation, risk factors for appendicitis.

Answer 1

dull peri-umbilical pain that is difficult to identify –> migrates to rigt iliac fossa.
Mcburneys tenderness, Rovsings sign (L palpation leads to R pain)
Psoas sign (indicates retro caecal appendix)

RF:
Family history – Twin studies suggest that genetics account for 30% of risk*
Ethnicity – More common in Caucasians
Environmental – Seasonal presentation during the summer

Question 2

appendicitis pathophysiology, complications

Answer 2

blockage of appendiceal lumen, usually due to faecolyth or lymphoid hyperplasia. commensal bacteria in the appendix can multiply, resulting in acute inflammation. reduced drainage + inflammation leads to increased pressure –> ischaemia –> can go onto perforate.

peritonitis, abscess formation if there is a delayed presentation.

Question 3

differential diagnosis of appendicitis

Answer 3

gynae-ovarian cyst rupture, ectopic pregnancy, pelvic inflammatory disease

renal- ureteric stones, urinary tract infection, pyelonephritis

GI-inflammatory bowel disease, Meckel’s diverticulum, or diverticular disease

urological- testicular torsion, epididymo-orchitis

Question 4

most common ages affected + investigations of appendicitis.

Answer 4

10-30 years

urinalysis- look for leukocytes
pregnancy test.

full blood count to ax inflammation + clotting + group and save.
USS 1st line scan

Question 5

management of appendicitis

Answer 5

gold standard is laproscopic appendectomy.

can be managed by abx but high failure rate.

send appendix off to histology as 1% can be caused by cancer.