Appendicitis

Question 1

What is McBurney’s point?

Answer 1

One third of the distance from the ASIS to the umbilicus

Question 2

What are the classic features of appendicitis?

Answer 2

-Tenderness at McBurney’s point

-Anorexia

-Nausea and vomiting

-Low-grade fever

-Rosving’s sign (palpation of the LIF causes pain in the RIF)

-Guarding on abdominal palpation

-Rebound tenderness

-Percussion tenderness

Rosving's Sign

Question 3

How is appendicitis diagnosed?

Answer 3

Clinical presentation and raised inflammatory markers

CT can be useful if another diagnosis is more likely

Ultrasound to exclude gynaecological pathology

Question 4

What is the next step if a patient has a clinical presentation suggestive of appendicitis but negative investigations

Answer 4

Diagnostic laparoscopy

Question 5

What are the key differential diagnoses of appendicitis?

Answer 5

Ectopic pregnancy
Ovarian cysts
Meckel’s diverticulum
Mesenteric adenitis (inflamed abdominal lymph nodes)

Question 6

What is mesenteric adenitis associated with?

Answer 6

Younger children
Tonsilitis
URTI

Question 7

What causes an appendix mass?

Answer 7

Omentum surrounds and sticks to inflamed appendix

Mass forms in the RIF

Question 8

How is appendicitis managed?

Answer 8

Appendicectomy

Question 9

What are the complications of appendicectomy?

Answer 9

Bleeding, infection, pain and scars

Damage to bowel, bladder or other organs

Removal of a normal appendix

VTE

Anaesthetic risks