Appendicitis Flashcards
Describe the epidemiology of appendicitis.
Any age, but peaks age 10-20
Most common surgical emergency.
Rare before age 2 because appendix not developed fully.
(OHCM)
Give 5 symptoms of appendicitis.
- Abdo pain starting in the umbilical area and localising to the RIF ‘like someone was twisting a knife’
- Loss of appetite/anorexia
- Constipation
- Diarrhoea
- Vomiting (rare)
What investigations would you do for suspected appendicitis?
Abdominal ultrasound
Blood tests: neutrophil leucocytosis, elevated CRP
CT useful. Reduces -ve appendicectomy rate, but may cause fatal delay.
(OHCM)
Describe the management of appendicitis.
- appendectomy.
- Antibiotics to reduce wound infections: metronidazole, cefuroxime
- Laparoscopy
Describe the pathogenesis of appendicitis.
Lumen obstruction causes gut organisms to invade the appendix wall. This leads to oedema, ischaemia necrosis and performation.
What is the ‘hygiene hypothesis’ in relation to appendicitis?
Improved hygiene and decreased exposure to pathogens may impair a person’s ability to prevent invasion of gut organisms into the appendix wall.
Give 5 signs of appendicitis.
- Guarding lying still with legs bent
- Tachycardia
- Fever
- Rebound and percussion tenderness in the RIF
- PR painful on right (sign of low-lying pelvic appendix)
Consider: child with vague abdo pain who will not eat their favourite food.
What is Rosving’s sign?
Pain is greater in the RIF than LIF when the LIF is pressed. Indicates appendicitis.
What is Psoas sign?
Pain on extending hip. Indicated appendicitis if retrocaecal appendix.
What is Cope sign?
Pain on flexion and internal rotation of right hip. Indicates appendicitis if appendix in close relation to obturator internus.
(OHCM)
Give 3 potential complications of appendicitis.
- Perforation
- Appendix mass
- Appendix abscess
