Appendicitis

Question 1

Define:

Answer 1

inflammation of the appendix

Question 2

Aetiology/risk factors:

Answer 2

Gut organisms invade after obstruction of the appendix lumen.

Faecolith - poo stone

Lymphoid hyperplasia - common in young people

undigested seeds

Filarial worms

Question 3

Epidemiology:

Answer 3

the most common cause of surgical emergency

Peak incidence in 10-20 years

Question 4

symptoms:

Answer 4

nausea
vomiting
Pain that starts at the umbilicus and migrates to the RIF in about 12 hours.
anorexia 
constipation or diarrhoea

Question 5

Signs:

Answer 5

Tachycardia
Fever
Pain on coughing
Lying still 
Rebound tenderness + guarding 
Furred tongue 
shallow breaths
Feotor +/- flushing

Rovsing’s sign - palpating the LIF causes more pain in the RIF
Psoas sign - pain extending the hip
Cope’s sign - pain internally rotating and flexing the hip

Question 6

Investigations:

Answer 6

Bloods - FBC (looking for WCC), CRP , pregnancy test (there can be gynae causes with similar presentations)

Ultrasound

CT

Question 7

Management:

Answer 7

Appendectomy - as soon as possible

Post- op - antibiotics + DVT prophylaxsis (heparin and anti-embolism socks)

Question 8

Complications:

Answer 8

perforation

appendix mass - inflamed appendix covered in omentum

appendix abscess - must be drained and given antibiotics.

Question 9

prognosis:

Answer 9

in uncomplicated most people resolve

If it ruptures then there are possibilities of complications such as sepsis and death