Appendicitis

Question 1

Explain the characteristic textbook presentation of appendicitis

Answer 1

Migrating abdominal pain - peribilical pain to RLQ. Commonly known as McBurney’s point (1/3 ASIS to umbilicus). This is due to embryologicAl dermatomal innervation by T10 segment - referred pain

Question 2

Identifying the appendix - surface landmark(s) and infernally

Answer 2

9cm approximately. Fixed base (landmarks) and variable tip. McBurney’s point - surface
2cm below ileocaecal valve, where all 3 taenia Coli converge, blind ended tube from caecum

Question 3

Physical exam tests to confirm appendicitis

Answer 3

Rebound tenderness
Rovsing’s sign - compress LLQ causes RIF pain secondary to parietal peritoneal distension from inflammation
Psoas sign - lateral cubitus position, hip extension brings on pain (tells you that the tip is retrocaecal)

Question 4

What are the different positions of the appendix tip?

Answer 4

Caecum:

1. Retrocaecal
2. Subcaecal
   - Pelvic

Ileum:

• Preileum
• Postileum

Question 5

What is the appendix supplied by?

Answer 5

Appendicular artery, branch of the posterior caecal artery. Venous drainage via appendiceal vein into ileocaecal vein –> portal vein –> sinusoids in liver –> IVC

Question 6

What nerves come from L1?

Answer 6

L1: iliohypogastric, ilioinguinal

L1, L2: genitofemoral nerve

Question 7

What is the obturator sign in physical examination?

Answer 7

Internal rotation of flexed right thigh causes obturator internus muscle to compress pelvic appendix and cause worsening RIF pain.