Appendicitis Flashcards
Examining an abdomen - what to do before you even touch patient?
- Get them to fully blow tummy out
- Then fully suck in
- Then cough
- Will see patients with peritonism doing very little movements and even localise their pain by putting a hand do it
- Then you can examine away from these areas first
Pathophys of appendicitis
- Luminal obstruction
- Faecolith or lymphoid hyperplasia (rarer malignancy can cause)
- Inflammation then occurs as bacteria multiply
- Increased pressure, reduced venous drainage –> ischaemia
- –> necrosis and can perforate
RF appendicitis
- FH
- Ethnicity - caucasions
- Environmental - summer
Presentation of appecidicitis
- Abdominal pain
- Poorly localised, dull peri-umbilical pain
- Later migrates to RIF
- Can have vomitting, anorexia, nausea or diarrhoea too
Examination appendicitis
- Rebound tenderness
- Percussion tenderness over McBurneys point
- Guarding esp if perforated
- In severe cases, signs of sepsis
Specific examination signs for appendicitis
- Rovsings sign - palpation of LIF causes pain in RIF
- Psoas sign - RIF pain on extension of R hip - retrocaecal appendix abutting psoas muscle
What is McBurneys point?
2/3 the way from umbilicus to ASIS
Appendicitis in children vs adults
- Childen can present atypical
- Can just be diarrhoea, urinary symptoms and left sided pain sometimes
- Always examine all systems and check genitals to exclude torsion
Differentials for appendicitis
- Ovarian cyst rupture, ovarian torsion, ectopic pregnancy, PID
- IBD, Meckels diveriticulum, diverticular disease
- Testicular torsion, epididymo-orchitis
- Ureteric stone, UTI, pyelonephritis
Based on anatomy in that area
Investigations for suspected appendicitis
- Urinalysis - assess for renal/urological cause
- Pregnancy test for women of reporductive age
- Routine bloods - FBC, CRP, Clotting screen, group&save, serum b-hCG if not excluded ectopic
Can get +ve leukocytes on urine dip due to local inflammation
Imaging for appendicitis
Clinical assessment with biochemical picture can diagnose
But due to wide differentials may need:
* USS - gynae and children
* CT - appendicitis, assess GI and urological
* MRI - 2nd line in children and women
Risk stratification scores appendicitis
- Men - appendicitis inflammatory response score
- Women - adult appendicitis score
- Children - Shera score
These are best for each group
Management appendicitis
- Laparascopic appendicectomy
- Certain cases can be trialled with abx alone if high risk surgery with uncomplicated
How management differs with appendiceal mass
- If mass, abx therapy
- Interval appendicetomy performed 6-8 weeks later
What is an appendiceal mass?
- Inflammatory phelgmon (acute inflam of soft tissues)
- Formed by body in response to acute appendicitis
- Oedematous and adherant omentum and small bowel loops form around appendix (almost becomes a sticky ball of inflammation)
- Can be diagnosed pre-op via exam and imaging