Appendicitis

Question 1

What is appendicitis.

Answer 1

Inflammation of the vermiform appendix (arises from the caecum).

Question 2

What is the incidence of appendicitis.

Answer 2

Lifetime incidence = 7%.
It is rare in the very old and very young. (rare in very young because the appendix is cone shaped with a larger lumen)
It is most common in those aged 10-20.

Question 3

What causes appendicitis.

Answer 3

It is due to a bacterial infection secondary to luminal obstruction (most often a faecalith or lymphoid hyperplasia)
This then leads to oedema, ischaemic necrosis and perforation.

Question 4

What are the symptoms of appendicitis. (7)

Answer 4

Anorexia.
Furred tongue.
Pain on coughing.
Foetor and/or flushing.
Shallow breathing.
Classically a colicky central abdominal pain (inflammation of the appendix) followed by a localisation of pain to the RIF (inflammation of overlying peritoneum).
Nausea, vomiting and constipation/diarrhoea are variable.

Question 5

What are the signs of appendicitis. (6)

Answer 5

Low grade pyrexia.
Patient tries to minimize movements.
RIF tenderness.
Guarding and rebound/percussion tenderness.
Right sided tenderness on PR.
Rovsing’s sign: RIF pain on palpation of LIF.

Question 6

What is the differential diagnosis for appendicitis. (6)

Answer 6

Ectopic pregnancy. 
Ovarian torsion. 
Diverticulitis (although pain is more common in LIF)
Pelvic inflammatory disease. 
Crohn's disease. 
Mesenteric adenitis.