Appendicitis Flashcards
What is a rectro-caecal appendix
Appendix is behind the caecum
What is a post-ileal appendix and where may pain be felt if you have this positioning
Appendix goes behind the ileum
Umbilical pain
What pain may be felt if a person has a pelvic appendix
Suprapubic pain
Define appendicitis
Inflammation of the appendix usually secondary to faecolith obstruction with subsequent bacterial overgrowth
What bacteria most commonly cause appendicitis
- B. fragilis
- E. Coli
What are the normal sequences of symptoms (3)
Anorexia
Abdominal Pain
Vomiting
Describe the pain classically felt in appendicitis
Initially visceral colicky pain initially in the umbilical region which then moves to the RIF and becomes constant
What would a high fever suggest
Abcess formation or perforation
What is meant by RIF peritonism
Pain on moving or coughing, guarding, rebound tenderness
Where is McBurney’s Point and what is its significance
1/3 of the way between the ASIS and the umbilicus
Where tenderness is often localised in appendicitis
What is Rovsing’s sign
LIF pain when pressing on the RIF
What is the PSOAS sign
Pain on extending hip
The psoas sign only works in which positioned appendix?
Retro-caecal
What is the cope/ obturator sign?
Pain on flexion and internal rotation of the right hip
What are the complications of appendicitis
Perforation
Generalised peritonitis
Abcess formation
Appendix mass
What is an appendix mass
Omentum and small bowel adhere to an inflammed appendix
What is the best imaging tool for appendicitis
Abdo-pelvis CT
When would ultrasound be chosen for imaging
Pregnancy
Paeds
What is the definitive treatment for acute appendicitis
Appendectomy
Describe an open appendectomy:
- Gridion incision at McBurney’s point, perp to spinoumbilical line
- Excise the appendix
How and when are antibiotics givens
IV
Before surgery and for 24 hours post
What would blood tests show in appendicitis
Raised WCC
Raised CRP
What would urine test show in appendicitis
May be white cells
What is Dunphy’s sign
Coughing causes point tenderness over McBurney’s
Classical symptoms of appendicitis (3)
Umbilical pain–> RIF
Anorexia
Constipation
Non classical symptoms (2)
D+v
How is an appendix mass diagnosed
US/ CT
Describe the management of an appendix mass
Initial conservative management with antibiotics
Interval
Delayed appendectomy
In 3 steps, describe the pathogenesis of appendicitis
- Lumen obstruction occurs
- Causes gut organisms to invade appendix wall
- Leads to oedema, ischaemic necrosis, perforation
What are some advantages of laparascopic appendectomy
Fewer complications including post op pain, abcess formation
What is the lifetime risk of appendicitis
1 in 15
How may a perforated appendicitis case present1
Persistent clinical symptoms lasting longer than 24 hours; signs of sepsis
Features of peritonism (rebound tenderness, guarding, rigidity); aggravated by light stimulation/movement
