Appendicitis

Question 1

Epidemiology

Answer 1

most common cause of acute abdominal pain requiring surgery.

Over 5% of the population develops appendicitis at some point.

Most common in teens and 20s but may occur at any age.

Question 2

Aetiology

Answer 2

obstruction of the appendiceal lumen, typically by lymphoid hyperplasia, but occasionally by a fecal, foreign body, or even worms. The obstruction leads to distention, bacterial overgrowth, ischemia, and inflammation.

Question 3

Pathogenesis

Answer 3

Appendicitis is acute inflammation of the vermiform appendix

Question 4

Natural History

Answer 4

necrosis, gangrene, and perforation occur. If the perforation is contained by the omentum, an appendiceal abscess results.

Without surgery or antibiotics (eg, in a remote location or historically), mortality is > 50%.

Question 5

clinical manifestations

Answer 5

epigastric or periumbilical pain followed by brief nausea, vomiting, and anorexia;

after a few hours, the pain shifts to the right lower quadrant.

Pain increases with cough and motion.

Question 6

symptoms

Answer 6

abdominal pain, anorexia, and abdominal tenderness

Question 7

signs

Answer 7

right lower quadrant direct and rebound tenderness located at the McBurney point

pain felt in the right lower quadrant with palpation of the left lower quadrant (Rovsing sign)
(psoas sign)
Low-grade fever

Question 8

Complications

Answer 8

rupture and development of an abscess or peritonitis

Question 9

Prognosis

Answer 9

With early surgery, the mortality rate is