Appendicitis

Question 1

What is appendicitis?

Answer 1

acute inflammation of the appendix

Question 2

Summarise the epidemiology of appendicitis

Answer 2

MOST COMMON surgical emergency
Can occur at any age
Most common: 10-20y

Question 3

Explain the aetiology of appendicitis

Answer 3

Luminal obstruction in ~50% due to:
Faecolith
Lymphoid hyperplasia during infection
Impacted stool
Appendiceal/ caecal tumour (rare)

Question 4

List 5 presenting symptoms of appendicitis

Answer 4

Periumbilical pain that moves to RIF + worsened by movement
Fever (low grade)
Anorexia
N+V
Constipation (sometimes diarrhoea)

Question 5

List 7 general signs of appendicitis on physical examination

Answer 5

Tachycardia
Fever (<38)
Furred/ dry tongue
Halitosis
Tenderness in RIF (max. at McBurney’s point)

Question 6

Where is McBurney’s point?

Answer 6

2/3s of the way from umbilicus to ASIS

Question 7

List 2 signs indicating peritonitis in appendicitis?

Answer 7

Guarding
Rebound + percussion tenderness

Question 8

List 3 peritoneal signs specific for acute appendicitis

Answer 8

Rovsing’s Sign: palpation of LIF causes more pain in RIF

Psoas Sign: pain on extending hip (caused by retrocaecal appendix)

Obturator Sign: pain on flexion + internal rotation of hip (occurs if appendix in close proximity to obturator internus)

Question 9

Which additional examinations should be considered in suspected peritonitis?

Answer 9

Scrotal + groin exam: ?hernia/ testicular torsion

Pelvic exam: ?ectopic

Question 10

List 3 variations in clinical picture in appendicitis

Answer 10

Retrocaecal appendix: RUQ pain

Kids: vague abdo pain + withdrawn

Old ppl: minimal pain/ fever, acute confusion + shock

Question 11

What investigations may be performed in appendicitis?

Answer 11

FBC: leucocytosis
CRP: high
Urine dip: r/o UTI
Pregnancy test: r/o ectopic

Question 12

Which imaging modalities may be used in appendicitis?

Answer 12

Thin males: clinical dx
USS: r/o pelvic organ pathology in females
CT: if diagnostic uncertainty

Question 13

Describe management for appendicitis

Answer 13

NBM
Analgesia IV
Laparoscopic appendicectomy
Prophylactic Abx: IV Ceftriaxone + Metronidazole

Question 14

List 3 possible complications of appendicitis

Answer 14

Perforation
Appendiceal mass
Appendiceal abscess

Question 15

What is an appendiceal mass?

Answer 15

inflamed appendix becomes covered with omentum

Question 16

What causes an appendiceal abscess?

Answer 16

If appendix mass fails to resolve
Tx: abdominal lavage + abx

Question 17

Why are appendix samples sent for histology?

Answer 17

Acute appendicitis can be a presentation of appendiceal cancer (although rare)