Appendicitis

Question 1

common in which group?

Answer 1

children but can occur in adults

Question 2

what are the symptoms and signs? 5

Answer 2

Vomiting, abdominal pain, RIF tenderness and increased WCC

anorexia - good diagnostic one

Question 3

what are some aetiology theories? 5

Answer 3

• Most are of unknown cause
• Faecoliths
• Hyperplasia of the lymphoid tissue in the wall of the appendix
• Parasites
• Tumours (rare)

Question 4

what may cause faecoliths?

Answer 4

dehydration

Question 5

what is the earliest morphological sign of appendicitis?

Answer 5

mucosal ulceration

Question 6

what is the pathology sequence? 5

Answer 6

1. mucosal ulceration
2. acute inflammation
3. this rapidly spreads through the wall causing peritonitis
4. serosal congestion
5. pus in lumen and wall thickens

Question 7

_____ are the cardinal finding?

Answer 7

neutrophils

Question 8

The condition may be rapidly fatal due to the development of _____

Answer 8

septicaemia

Question 9

histologically you get

• Mucosal ulceration and mural inflammation
• ______ infestation in the lumen which invades the appendix wall

Answer 9

neutrophil

Question 10

what are some complications? 5

Answer 10

• peritonitis
• rupture
• abscess
• fistula
• sepsis

Question 11

sepsis is ___ ____ in nature

Answer 11

gram negative

Question 12

how does the abscess form?

Answer 12

mesentry wrapping around the inflammation

Question 13

how does a fistula develop?

Answer 13

Fistula - erosion into other organs - this is an abnormal connection

Question 14

peritonitis can be fatal with? 4 things

Answer 14

• age
• immunosuppression
• diabetes
• no omentum

Question 15

what are the general signs? 4

Answer 15

• mild pyrexia
• mild tachycardia
• guarding
• rebound

Question 16

what are the specific signs? 3

Answer 16

• rovsing’s
• psoas
• obturator

Question 17

what is rovsing’s ?

Answer 17

Rovsings: Pressing on the left causes pain on the right

Question 18

what is psoas?

Answer 18

Psoas: —Patient keeps the right hip flexed as this lifts an infmaled appendix off the psoas

Question 19

what is obturator sign?

Answer 19

Obturator:—If appendix is touching obturator internus, flexing the hip and internally rotting will cause pain

Question 20

the retrocaecal appedix may have very ___ signs

Answer 20

few

Question 21

in pelvic appendix the patient may experience ____ , ___ of ___

Answer 21

—Diarrhoea, frequency of micturition

Question 22

in postileal appendix the patient may experience ____ , ___

Answer 22

diarrhoea and vomiting

Question 23

what is the Differential diagnosis for children? 6

Answer 23

—Gastroenteritis
—Mesenteric adenitis
—Meckel’s diverticulum
—Intususseption
—Henoch-Schonlein Purpura
—Lobar pneumonia

Question 24

what is the differential diagnosis for adults ? 6

Answer 24

—Terminal ileitis
—Ureteric colic
—Acute pyelonephritis
—Perforated ulcer
—Pancreatitis
—Rectus sheath haemotoma

Question 25

what is the Differential diagnosis for elderly/ 3

Answer 25

—Sigmoid diverticulitis
—Intestinal obstruction
—Carcinoma of the caecum

Question 26

what is the Differential diagnosis for women? 4

Answer 26

—Mittelschmerz
—Ovarian cyst
—Salpingitis
—Ectopic pregnancy

Question 27

what are the first line investigations ? 5

Answer 27

FBC
Abdo and pelvic CT
urinary pregnancy test

consider
USS and urinalysis

Question 28

what would you find in blood tests

Answer 28

high CRp and WCC

Question 29

what is the management of acute appendicitis ? 2

Answer 29

Appendectomy and supportive
- Usually laparoscopic
IV antibiotic therapy

Question 30

what is the management of appendix mass ? 2

Answer 30

1st line - IV antibiotics and supportive

can operate or not

Question 31

when would you operate for appendix mass? 4

Answer 31

—if they have 
Tachycardia
—Worsening pain
—Increase in size
—Vomiting or copious NG aspirates (ileus)

Question 32

what is the management of appendix abscess ? 2

Answer 32

Treatment - Iv antibiotic therapy with drainage ± interval appendectomy