Appendicitis Flashcards
What is appendicitis?
Appendicitis is inflammation of the appendix and is the most common indication for emergency surgery in paediatric patients
What percent of children presenting with acute abdominal pain will be diagnosed with acute appendicitis?
20-30%
What is the appendix?
The appendix is an intraperitoneal hollow outpouching of the gut which arises from the caecum where the three teniae coli meet.
It is suspended, by the mesoappendix, from the terminal portion of the ileum and commonly sits retrocaecally.
The appendix is thought to act as a reservoir for intestinal flora which allows the gut to replenish its microbiome after gastroenteritis, but there are usually no long-term consequences to removing it
What is the pathophysiology of appendicitis?
he typical cause of inflammation is obstruction of the opening of the appendix, as a result of either a faecolith (hardened stool) or lymphoid hyperplasia
What are teniae coli?
three separate longitudinal ribbons of smooth muscle that run the length of the colon
What is a faecolith?
Calcified faeces
In which decade is appendicitis most common?
second decade of life
Describe the migration of pain seen in appendicitis:
pain typically starts as central umbilical pain which moves down into the right iliac fossa
Other than abdominal pain, give 4 symptoms of appendicitis:
1) nausea and vomiting
2) low-grade fever
3) diarrhoea
4) anorexia (loss of appetite)
Explain why there is a migration of pain from the umbilicus to the right iliac fossa in appendicitis:
the initial inflammation stimulates the visceral afferent pain fibres which correspond to the T10 dermatome producing umbilical pain -> as the appendix becomes more inflamed, it irritates the parietal peritoneum which activates somatic nerve fibres and produces localised pain in the right iliac fossa
At which anatomical point is pain found in appendicitis?
McBurney’s point
Give 3 examinations findings associated with appendicitis:
1) tenderness in the right iliac fossa
2) guarding due to localised peritonitis
3) rebound tenderness in the right iliac fossa
What is rebound tenderness?
where there is increased pain when suddenly releasing the pressure of deep palpitation
Give four examination tests for appendicitis:
1) Rovsing’s sign
2) Psoas sign
3) Obturator sign
4) Hop test
Describe Rovsing’s sign:
palpation of the left iliac fossa causes right iliac fossa pain
Describe psoas sign:
extension of the right thigh in the left lateral position causes right iliac fossa pain
Describe the obturator sign:
internal rotation of the flexed right thigh causes pain
Describe the hop test:
hopping or jumping causes abdominal pain
Describe the anatomical position of McBurney’s point:
one third of the distance from the anterior superior iliac spine to the umbilicus
What is the name of the triad of classic symptoms seen in appendicitis?
Murphy’s triad
Give the three symptoms of Murphy’s triad:
1) nausea and vomiting
2) low-grade fever
3) right iliac fossa pain
Name 4 laboratory tests indicated in suspected appendicitis:
1) FBC (raised WCC)
2) U+E (nausea and vomiting can derange renal func.)
3) CRP (suggestive of inflammation)
4) Group and save (to identify blood type which will be needed for surgery)
Name three forms of imaging that may be used to view an inflamed appendix?
1) ultrasound scan
2) CT scan
3) MRI scan
Give 3 ultrasound scan findings that indicate appendicitis:
1) non-compressible appendix larger than 6mm
2) wall thickening
3) free fluid within the right iliac fossa
Name four conditions that mimic symptoms of appendicitis:
1) Meckel’s diverticulitis
2) Ovarian cysts
3) Ectopic pregnancies
4) Mesenteric adenitis
What is Meckel’s diverticulitis?
inflammation of a congenital outpouching of the small intestine that is a remnant of the umbilical cord (which is present in 2% of the population)
True or false: all females of a child bearing age should be assumed to be pregnant until proven otherwise when presenting with abdominal pain
true (especially important in appendicitis when requesting X-rays and CT scans)
What is the name for inflamed abdominal lymph nodes associated with tonsillitis and URTIs?
mesenteric adenitis
How does mesenteric adenitis present?
Similar to acute appendicitis (fever, vomiting, abdominal pain)
What is the most common treatment for acute appendicitis?
laparoscopic appendicectomy
What is an appendix mass?
where the omentum sticks to the inflamed appendix, forming a mass
How does treatment of an appendix mass differ from treatment of a normal appendicitis?
antibiotic therapy is commenced and the appendicectomy is delayed by several months to allow inflammation to settle
Name and explain the new appendicitis management strategy that does not use appendicectomies:
active observation - patients are given fluids and antibiotics and monitored
Give 4 complications associated with appendicitis surgery:
- Bleeding, infection, pain and scars
- Damage to bowel, bladder or other organs
- Removal of a normal appendix
- Venous thromboembolism (deep vein thrombosis or pulmonary embolism)
What are the complications of a delay in presentation with appendicitis?
Perforation, leading to generalised peritonitis
Abscess formation, usually requiring drainage
