Appendicitis

Question 1

What is appendicitis?

Answer 1

Acute inflammation of the appendix - a small thin tube arising from the caecum

Question 2

What is the epidemiology of appendicitis?

Answer 2

Acute appendicitis most commonly occurs between ages 10 and 20

Question 3

What is the aetiology of appendicitis?

Answer 3

Pathogens can get trapped at the point where the appendix meets the bowel - this causes infection and inflammation. This can proceed to gangrene and rupture

Question 4

What is the presentation of appendicitis?

Answer 4

Loss of appetite
Nausea and vomiting
Low grade fever
Abdominal guarding
Abdominal pain - periumbilical pain that moves to the RIF
Rovsing’s sign - palpation of LIF causes tenderness in RIF
Rebound tenderness

Question 5

What investigations can be performed to diagnose appendicitis?

Answer 5

FBC
CRP
U&Es
Group and save
Abdominal ultrasound - exclused ovarian and gynae pathology
Contrast-enhanced abominal CT - first diagnostic test in adults

Question 6

What are the differential diagnoses of appendicitis?

Answer 6

Ectopic pregnancy
Ovarian cysts
Meckel’s diverticulum
Mesenteric adenitis
Gastroenteritis
Intussusception
UTI

Question 7

What is the definitive management of appendicitis?

Answer 7

Laparoscopic appendectomy (with prophylactic antibiotics before surgery)

Question 8

What other treatment options are there for appendicitis?

Answer 8

Supportive treatment
- Nil by mouth if being considered for surgery
- IV maintenance fluids
- Analgesia

Question 9

What are the complications of appendicitis?

Answer 9

Perforation of appendix
Peritonitis
Surgical wound infection
Abscess on appendix

Question 10

What is the initial management of appendicitis?

Answer 10

Fluids
Analgesia
Antiemetics
Pre-operative antibiotics