Appendicitis

Question 1

What are complications of appendicitis?

Answer 1

Perforation Necrosis

Question 2

What are the mechanisms of pathology of appendicitis?

Answer 2

Obstruction due to most commonly faeces (faecolith) or e.g. worms (rare) Lymphoid hyperplasia - e.g. in response to infection

Question 3

Clinical features of appendicitis

Answer 3

Central abdominal pain that localises to Right Illiac Fossa (As appendicitis is a mid gut visceral structure so innervation refers to umbilical / region but then as surrounding peritoneum gets affected, the pain localises to the RIF)

Rovsings sign - pressing on LIF moves bowel to right and causes RIF tenderness

Colicky pain

Fever Nausea and vomiting

Question 4

Examination Findings of Appendicitis

Answer 4

Guarding Rigidity Generalised / localised tenderness Rebound tenderness

Question 5

What is Mcburney’s point?

Answer 5

2/3 between the umbilicus and the ASIS It is where the pain localises to in appendicitis

Question 6

What investigations do you do for appendicitis?

Answer 6

Bed side: urine dip Bloods: FBC (to include WCC) CRP Beta HcG Imaging: Ultrasound - to exclude gynae symptoms too

CT - for atypical

erect CXR to rule out perforation

Question 7

Name differential diagnoses for appendicitis Especially in kids and females

Answer 7

Diverticular disease Mesenteric adenitis (classic in kids) Inflammatory bowel disease Cancer Renal colic Female: ovarian cyst rupture or torsion Ectopic pregnancy Pelvis inflammatory disease

Question 8

Management

Answer 8

Conservative: Active observation Nil by mouth Analgesia IV fluids Medical: antibiotics e.g. amoxicillin and metronidazole

Surgical: appendicectomy open vs. Laparoscopic ( good for girls because you can have a look around in abdomen for other causes)

+/- abdominal lavage if perforation

Question 9

What are the type of scars you can get from open appendectomy?

Answer 9

Lanz is the horizontal one

grid-iron scar goes through McBurney’s point and is oblique