Appendicitis

Question 1

What is a rectro-caecal appendix

Answer 1

Appendix is behind the caecum

Question 2

What is a post-ileal appendix and where may pain be felt if you have this positioning

Answer 2

Appendix goes behind the ileum

Umbilical pain

Question 3

What pain may be felt if a person has a pelvic appendix

Answer 3

Suprapubic pain

Question 4

Define appendicitis

Answer 4

Inflammation of the appendix usually secondary to faecolith obstruction with subsequent bacterial overgrowth

Question 5

What bacteria most commonly cause appendicitis

Answer 5

• B. fragilis

- E. Coli

Question 6

What are the normal sequences of symptoms (3)

Answer 6

Anorexia
Abdominal Pain
Vomiting

Question 7

Describe the pain classically felt in appendicitis

Answer 7

Initially visceral colicky pain initially in the umbilical region which then moves to the RIF and becomes constant

Question 8

What would a high fever suggest

Answer 8

Abcess formation or perforation

Question 9

What is meant by RIF peritonism

Answer 9

Pain on moving or coughing, guarding, rebound tenderness

Question 10

Where is McBurney’s Point and what is its significance

Answer 10

1/3 of the way between the ASIS and the umbilicus

Where tenderness is often localised in appendicitis

Question 11

What is Rovsing’s sign

Answer 11

LIF pain when pressing on the RIF

Question 12

What is the PSOAS sign

Answer 12

Pain on extending hip

Question 13

The psoas sign only works in which positioned appendix?

Answer 13

Retro-caecal

Question 14

What is the cope/ obturator sign?

Answer 14

Pain on flexion and internal rotation of the right hip

Question 15

What are the complications of appendicitis

Answer 15

Perforation
Generalised peritonitis
Abcess formation
Appendix mass

Question 16

What is an appendix mass

Answer 16

Omentum and small bowel adhere to an inflammed appendix

Question 17

What is the best imaging tool for appendicitis

Answer 17

Abdo-pelvis CT

Question 18

When would ultrasound be chosen for imaging

Answer 18

Pregnancy

Paeds

Question 19

What is the definitive treatment for acute appendicitis

Answer 19

Appendectomy

Question 20

Describe an open appendectomy:

Answer 20

• Gridion incision at McBurney’s point, perp to spinoumbilical line
• Excise the appendix

Question 21

How and when are antibiotics givens

Answer 21

IV

Before surgery and for 24 hours post

Question 22

What would blood tests show in appendicitis

Answer 22

Raised WCC

Raised CRP

Question 23

What would urine test show in appendicitis

Answer 23

May be white cells

Question 24

What is Dunphy’s sign

Answer 24

Coughing causes point tenderness over McBurney’s

Question 25

Classical symptoms of appendicitis (3)

Answer 25

Umbilical pain–> RIF
Anorexia
Constipation

Question 26

Non classical symptoms (2)

Answer 26

D+v

Question 27

How is an appendix mass diagnosed

Answer 27

US/ CT

Question 28

Describe the management of an appendix mass

Answer 28

Initial conservative management with antibiotics
Interval
Delayed appendectomy

Question 29

In 3 steps, describe the pathogenesis of appendicitis

Answer 29

• Lumen obstruction occurs
• Causes gut organisms to invade appendix wall
• Leads to oedema, ischaemic necrosis, perforation

Question 30

What are some advantages of laparascopic appendectomy

Answer 30

Fewer complications including post op pain, abcess formation

Question 31

What is the lifetime risk of appendicitis

Answer 31

1 in 15

Question 32

How may a perforated appendicitis case present1

Answer 32

Persistent clinical symptoms lasting longer than 24 hours; signs of sepsis
Features of peritonism (rebound tenderness, guarding, rigidity); aggravated by light stimulation/movement