Appendicitis

Question 1

Which organisms are commonly associated with/w appendicitis

Answer 1

(Faecal)
Ecoli
Peptostreptococcus species
Bacteroides fragilis
Pseudomonas

Question 2

WHO mostly gets appendicitis

Answer 2

Second decade of life
Advanced disease common in children younger than 6 occurring in up to 57% of cases

Question 3

Classical Symptoms of appendicitis

Answer 3

Anorexia (nausea and vomiting ??)
Periumbilical pain radiating to right lower quadrant
Pain on movement
Vomiting
Fever

Question 4

Signs of appendicitis (on examination)

Answer 4

Right lower quadrant tenderness
Localised or generalised peritonism
Guarding with abdo palpating
Rebound tenderness
Rovsig sign (pain on right LQ on palpating of LLQ)
Obturator sign (pain on flexion and internal rotation of the right hip, irritated obturator inter us muscle)
Iliopsoas sign(pain on extension of right hip)

Question 5

Which investigationwould you do to diagnose appendicitis

Answer 5

FBC (WCC)
Neutrophil count
CRP
Sodium/potassium (not diagnostic)
Do Urinalysis to exclude UTI

Imagining:Ultrasonogram (thickness >6-7mm), faecalith can he seen

Question 6

Differential

Answer 6

GIT
-mesenteric adenitis
Gastroenteritis
Intessusception
Constipation
Meckels diverticulum

Gynae (you know them)
PID, Ectopic, ovarian cyst torsion, rupture of ovarian cyst

Extraabdomina
Pneumonia
Strept pharyngitis
Haemolytic Uraemic Syndrome

Question 7

Management of appendicitis

Answer 7

Dx warrants appendicectomy
Laparoscopic or open

Make dx
Admit to ward
Start analgesi (IV or oral)
Start IV antibiotics
Provide fluids
Provide antiemetics
Surgery (consent and do)
Post op care and prep for discharge

Question 8

Implications of appendicectomy

Answer 8

Wound infection
Intraabdominal abscess
Constipation
Paralytic ileus
Intessusception
Small bowel obstruction