Appendicitis

Question 1

What is pathogenesis that leads an appendicitis to develop?

Answer 1

Lumen obstruction by lymphoid hyperplasia, faecolith etc

Obstruction leads to oedema, necrosis and perforation

Question 2

What are the symptoms of appendicitis?

Answer 2

Periumbilical pain that moves to the RIF, anorexia, N+V, constipation, altered bowel habit, diarrhoea may occur (latter 2 in pelvic positioned appendicitis)

Question 3

Name the three special signs and what they are for appendicitis?

Answer 3

Rovsings sign - there is pain in the LIF when RIF is pressed
Psoas sign - pain on extending hip (if retrocecal appendicitis)
Cope sign - pain on flexion and inward rotation (if near to obturator internus)

Question 4

Despite being a mainly clinical diagnosis, what investigations should be done?

Answer 4

Bloods (Raised WBC and CRP) and an USS

If still unclear about diagnosis, do a CT scan, if there is time!

Question 5

Name 5 general signs that may occur during an appendicitis?

Answer 5

Tacky, fever, furred tongue, coughing hurts, flushing, shallow breathing, guarding, rebound tenderness, PR painful on right side

Question 6

What is the treatment?

Answer 6

Prompt appendectomy, antibiotics (cefuroxime+metronidazole) post-op to prevent infection

Question 7

What surgical approaches might you use?

Answer 7

Laparoscopic, traditional griridon incisure and cosmetic lanz incisure

Question 8

Complications of appendicitis include what?

Answer 8

Perforation, appendix mass, appendix abscess

Question 9

Differential diagnosis for appendicitis to consider? Name 5…

Answer 9

Ectopic pregnancy, UTI (check urine!), cystitis, cholecystits, diverticulitis, salpingitis, dysmenorrhea, Crohn’s disease, perforated ulcer, food poisoning

Question 10

In which age group is acute appendicitis most common?

Answer 10

10-20 yr olds