Appendicitis

Question 1

What are the causes of appendicitis?

Answer 1

1. Lymphoid tissue hyperplasia, faeces, worms, foreign body.
2. Obstruction of appendiceal lumen.
3. Stasis.
4. Bacterial overgrowth.

Question 2

How does appendicitis present?

Answer 2

Periumbilical pain (visceral splanchnic nerves) - localises to RIF (peritoneal involvement).
Pain worse on coughing and moving.
N&V.
Fever.
Diarrhoea common.
Tachycardia.
Increased WCC and CRP.
Roving’s sign - palpation in LIF causes RIF tenderness.
If perforated may be PERITONITIC (guarding and rebound tenderness).

Question 3

What is the blood supply to the appendix and why can this be a problem?

Answer 3

Sole blood supply from the appendicular artery so can thrombose and lead to gangrene.

Question 4

What are the possible complications of appendicitis?

Answer 4

Perforation.
Peritonitis.
Abscess (swinging fevers).

Question 5

What investigations are performed for suspected appendicitis?

Answer 5

Contrast CT - good sensitivity and specificity.

USS - Can be inconclusive, esp if overlying bowel gas means you can’t see it hence not good at ruling out ddx.

Question 6

How is appendicitis managed?

Answer 6

Fluid resus.
IV abx.
Open or laparoscopic appendectomy - open good on smaller abdomens as risk of laproscopic ports causing damage on insertion (e.g. children). MCBURNEY’S POINT - 2/3 from umbilicus to ASIS. Lapro good for larger patients and women (to visualise gynae structures - ddx).