Appendicitis

Question 1

Different positions of the appendix

Answer 1

Pre-ileal – Anterior to the terminal ileum – 1 o’clock.
Post-ileal – Posterior to the terminal ileum – 2 o’clock.
Sub-ileal – Parallel with the terminal ileum – 3 o’clock.
Pelvic – Descending over the pelvic brim – 5 o’clock.
Sub-caecal – Below the cecum – 6 o’clock.
Paracaecal – Alongside the lateral border of the cecum – 10 o’clock.
Retrocaecal – Behind the cecum – 11 o’clock.

Question 2

Most common positions of the appendix

Answer 2

Retrocaecal and subileal

Question 3

Arterial and venous supply of the appendix

Answer 3

Appendicular artery (from Ileocolic artery -> SMA) and appendicular vein

Question 4

Nerve supply for appendix

Answer 4

Superior mesenteric plexus (ileocolic branch)

Question 5

Appendicitis

Answer 5

Acute inflammation of the appendix

Question 6

Typical presentation of appendicitis

Answer 6

Acute abdominal pain starting in the mid-abdomen and later localising to the right lower quadrant.

Associated fever, nausea and vomiting, anorexia

Question 7

Common causes of appendicitis

Answer 7

Young due to increase in lymphoid tissue which occludes the appendix
Faecolith (hard faecal mass)

Question 8

Most common bacteria in the appendix

Answer 8

Escherichia Coli and Bacteroides Fragilis

Question 9

Signs for appendicitis

Answer 9

Rovsing’s sign- Pressing the left side of the abdominal cavity and eliciting pain in right lower quadrant.

Psoas sign- Extending the right thigh on left lateral position elicits pain in right lower quadrant.

Obturators sign- Pain is elicited at right lower quadrant of abdomen by internal rotation of the flexed right thigh.

Question 10

Management of appendicitis

Answer 10

NBM
IV Fluids
Appendectomy

Question 11

Alvarado score

Answer 11

RLQ tenderness (2)
Elevated temp 37.3 (1)
Rebound tenderness (1)
Migration of pain to RLQ (1)
Anorexia (1)
Nausea and vomiting (1)
Leukocytosis <10000 (2)
Leukocyte left shift (1)

> 5 unlikely >7 probable