Appendicitis Flashcards
What is the pathoogenesis of appendicitis?
Luminal obstruction leads to bacterial overgrowth, causing inflammation and swelling. This increases pressure leading to localized ischemia, gangrene and can lead to perforation
What causes appendicitis? In children and in adults.
children: Hyperplasia of lyphoid follicles initiated by an infection
Adults: fibrosis/stricture, fecolith, obstructing neoplasm
Other: parasites, foreign body
What are the clinical features of appendicitis?
- Low grade fever (38 C) rises with perf
- Abdo pain, then anorexia
- Classic pattern - periumbilical initially, contant poorly localized, moving to well localized pain over McBurney’s point.
What is McBurney’s sign?
Tenderness 1/3 the distance from the ASIS to the umbilicus on the right side
What is Rosving’s sign?
Palpation pressure to the left abdomen causes McBurney’s point tenderness
What is Psoas sign?
Pain on flexion of the hip against resistance or passive hyperextention of the hip
What is obturator sign?
Flexion and then extrernal or internal rotation about the hip causes pain.
What 2 complications of appendicitis?
1) Perforation
2) Abscess, Phlegmon
What laboratoy investigations should you order with suspected appendicitis? What do you add if female?
- CBC - mild leukocytosis, L shift
- urinalysis
- B-hCG
What imaging studies would you order for suspected appendicitis?
- U/S: Can rule appendicitis in but can’t rule out. Also good tool to rule out gyne causes
- X-ray: Free air (perforation)
- CT Scan Abdo-pelvis (gold standard) Thick wall, appendicolith, inflammatory changes
What is the treatment for appendicitis?
- Hydrate, correct electrolytes
- Surgery and antibiotic therapy
Which antibiotics (2) would you use pre-operatively?
1) Cefazolin
2) Metronidazole
