Appendicitis Flashcards
common in which group?
children but can occur in adults
what are the symptoms and signs? 5
Vomiting, abdominal pain, RIF tenderness and increased WCC
anorexia - good diagnostic one
what are some aetiology theories? 5
- Most are of unknown cause
- Faecoliths
- Hyperplasia of the lymphoid tissue in the wall of the appendix
- Parasites
- Tumours (rare)
what may cause faecoliths?
dehydration
what is the earliest morphological sign of appendicitis?
mucosal ulceration
what is the pathology sequence? 5
- mucosal ulceration
- acute inflammation
- this rapidly spreads through the wall causing peritonitis
- serosal congestion
- pus in lumen and wall thickens
_____ are the cardinal finding?
neutrophils
The condition may be rapidly fatal due to the development of _____
septicaemia
histologically you get
- Mucosal ulceration and mural inflammation
- ______ infestation in the lumen which invades the appendix wall
neutrophil
what are some complications? 5
- peritonitis
- rupture
- abscess
- fistula
- sepsis
sepsis is ___ ____ in nature
gram negative
how does the abscess form?
mesentry wrapping around the inflammation
how does a fistula develop?
Fistula - erosion into other organs - this is an abnormal connection
peritonitis can be fatal with? 4 things
- age
- immunosuppression
- diabetes
- no omentum
what are the general signs? 4
- mild pyrexia
- mild tachycardia
- guarding
- rebound
what are the specific signs? 3
- rovsing’s
- psoas
- obturator
what is rovsing’s ?
Rovsings: Pressing on the left causes pain on the right
what is psoas?
Psoas: Patient keeps the right hip flexed as this lifts an infmaled appendix off the psoas
what is obturator sign?
Obturator:If appendix is touching obturator internus, flexing the hip and internally rotting will cause pain
the retrocaecal appedix may have very ___ signs
few
in pelvic appendix the patient may experience ____ , ___ of ___
Diarrhoea, frequency of micturition
in postileal appendix the patient may experience ____ , ___
diarrhoea and vomiting
what is the Differential diagnosis for children? 6
Gastroenteritis Mesenteric adenitis Meckel’s diverticulum Intususseption Henoch-Schonlein Purpura Lobar pneumonia
what is the differential diagnosis for adults ? 6
Terminal ileitis Ureteric colic Acute pyelonephritis Perforated ulcer Pancreatitis Rectus sheath haemotoma
what is the Differential diagnosis for elderly/ 3
Sigmoid diverticulitis
Intestinal obstruction
Carcinoma of the caecum
what is the Differential diagnosis for women? 4
Mittelschmerz
Ovarian cyst
Salpingitis
Ectopic pregnancy
what are the first line investigations ? 5
FBC
Abdo and pelvic CT
urinary pregnancy test
consider
USS and urinalysis
what would you find in blood tests
high CRp and WCC
what is the management of acute appendicitis ? 2
Appendectomy and supportive
- Usually laparoscopic
IV antibiotic therapy
what is the management of appendix mass ? 2
1st line - IV antibiotics and supportive
can operate or not
when would you operate for appendix mass? 4
if they have Tachycardia Worsening pain Increase in size Vomiting or copious NG aspirates (ileus)
what is the management of appendix abscess ? 2
Treatment - Iv antibiotic therapy with drainage ± interval appendectomy
