Appendicitis

Question 1

Define appendicitis

Answer 1

Acute inflammation of the vermiform appendix, mainly due to obstruction of the lumen of the appendix

Most common surgical emergency of the abdomen.

Question 2

Describe epidemiology of appendicitis

Answer 2

More common in males than females.
Most common in individuals aged 10-19 years.

Question 3

What are the clinical features of appendicitis?

Answer 3

1. Migrating abdominal pain that starts central (peri-umbilical) and moves to the right lower quadrant (RLQ), worse on movement and coughing.
2. Non-specific symptoms: nausea, vomiting, anorexia (almost always present), mild fever (37.5-38.5°C), diarrhoea, constipation.
3. RLQ tenderness (McBurney point tenderness).
4. Rovsing’s Sign: RLQ pain when LLQ is deeply palpated.
5. Psoas Sign: pain on extending hip if appendix is in retrocaecal position.
6. Obturator Sign: pain on internal rotation of flexed thigh.
7. Blumberg Sign: rebound tenderness in RLQ.

Question 4

What bedside investigations can be done in appendicitis?

Answer 4

• Abdominal examination
• Basic observations
• Also Urinalysis (exclude UTI)and to perform a Pregnancy Test (if they are of child bearing age with RIF/LIF pain)

Question 5

What blood tests are done in suspected appendicitis?

Answer 5

FBC shows neutrophil-predominant leukocytosis in 80-90%.
CRP is elevated.

Question 6

What imaging is done for suspected appendicitis?

Answer 6

1. Abdominal Ultrasound: first line in pregnant women and helps rule out ovarian pathology - rapid and bedside
2. Contrast-Enhanced Abdominal CT: if ultrasound is inconclusive or malignancy is suspected.
3. Erect CXR: if perforation is suspected.
4. Abdominal MRI.

Question 7

What is the Alvarado score acronym?

Answer 7

MANTRELS.

Question 8

What is the first choice for untreated appendicitis?

Answer 8

Laparoscopic appendicectomy within 24 hours of diagnosis.

Question 9

How do we manage patients before laparoscopic appendicectomy?

Answer 9

Prophylactic antibiotics (cefuroxime and metronidazole), keep patient NBM, and provide analgesia and fluids.

Question 10

What do we do in a complicated appendicitis case/perforated appendicitis?

Answer 10

Urgent appendicectomy; patient may show signs of sepsis or shock.

Question 11

What happens to patients without peritonitis with an appendix mass?

Answer 11

They are given broad-spectrum antibiotics and considered for interval appendicectomy.

Question 12

What complications are there of appendicitis?

Answer 12

1. Pelvic Abscess (post-appendicectomy): pain, fever, sweats, mucus diarrhoea - requires drainage.
2. Perforation: leads to peritonitis.

Question 13

How is prognosis for patients with appendicitis?

Answer 13

Good if treated in a timely fashion; laparoscopic appendicectomy decreases incidence of overall complications.