Appendicitis Flashcards
When does appendicitis most commonly occur?
2nd and 3rd decade of life
What are the possible positions of the appendix, and which is most common?
Retrocaecal = most common (75% of cases)
Pre-ileal
Post-ileal
Pelvic
Post-caecal
What is the blood supply to the appendix?
Appendicular artery (branch of the ileo-colic artery)
What is the pathophysiology of appendicitis?
The lumen of the appendix is obstructed -> this leads to the multiplication of commensal bacteria behind the obstruction -> resulting in acute inflammation of the appendix
How does perforation of the appendix occur?
The localised inflammation and reduced venous drainage leads to increased pressure within the appendix -> this causes ischaemia within the appendiceal wall
Untreated ischaemia results in necrosis and perforation
What causes the appendix to become obstructed?
Faecolith (most common)
Tumours (appendix or caecum)
Lymphadenopathy
Foreign bodies
What are the specific examination signs of appendicitis?
- Rovsing’s: RIF pain on palpation of LIF
- Psoas: RIF pain on extension of the right leg (due to irritation of the psoas muscle or the peritoneum overlying it by the inflamed appendix)
- Obturator: pain on flexion and internal rotation of the hip (due to irritation of the obturator internus by the inflamed appendix)
What scoring systems are used for appendicitis?
Appendicitis Inflammatory Response Score - preferred option for men
Alvarado Score - predicts the likelihood of appendicitis
How to consent for a diagnostic laparoscopy +/- appendicectomy?
- Check identity
- Explain the operation
- Explain the indication and benefits
- Explain alternatives e.g. treating with antibiotics - but advise that this isn’t recommended
- Explain risks including conversion to open surgery, collections, the need for drainage or repeat surgery, future hernias and the small risk of needing a bowel resection
What are the complications of appendicitis?
Perforation
Collections and pelvic abscesses
Appendiceal mass
