Appendicitis

Question 1

Diagnostic criterial for appendicitis

Answer 1

Alvarado score (mnemonic MANTRELS)

M: Migration of pain to right lower quadrant = 1 point

A: Anorexia = 1 point

N: Nausea and vomiting = 1 point

T: Tenderness in right lower quadrant = 2 points

R: Rebound tenderness = 1 point

E: Elevated temperature = 1 point

L: Leukocytosis = 2 points

S: Shift of WBC count to left = 1 point

Question 2

Signs in appendicitis

Answer 2

1. Rovsing: Pain in RLQ when palpated in LLQ
2. Mc burneys point
3. Obturator sign: Pain on passive INTERNAL rotation of the hip when the right knee is flexed. It is present when the inflamed appendix is in contact with the obturator internus muscle.
4. Kocher sign: pain @epigastrium migrating to RLQ

Question 3

Inv in appendicitis

Answer 3

Initial: USG
Best: CT

In preg - USG
if >34wks - CT

Question 4

Mx of appendicitis

Answer 4

Supportive care
NBM IV fluids
`Analgesia

Appendectomy remains standard of care

IV antibiotics