Appendicitis

Question 1

Define appendicitis

Answer 1

Acute inflammation of the appendix

Question 2

What are the causes/risk factors of appendicitis?

Answer 2

Often caused by obstruction of appendix with a faecolith (may also be caused by normal
stool, infective agents or lymphoid hyperplasia)

Question 3

What are the symptoms of appendicitis?

Answer 3

• Central abdominal pain which later localises to right iliac fossa
• Nausea
• Vomiting
• Diarrhoea
• Fever
• Anorexia

Question 4

What are the signs of appendicitis?

Answer 4

• Fever
• Tachycardia
• Furred tongue
• McBurney’s sign – right iliac fossa tenderness
• Rosving’s sign – pain is elicited in RIF by pressing on LIF
• Psoas Sign - pain on extending the hip (caused by retrocaecal appendix)
• Cope Sign - pain on flexion and internal rotation of the hip (occurs if the appendix is in close proximity to the obturator internus)
• Rebound tenderness
• Tender mass (appendix abscess)

Question 5

What are some differential diagnoses for appendicitis?

Answer 5

• Non-specific mesenteric lymphadenitis
• Terminal ileitis (Crohn’s or Yersinia infection)
• Acute salpingitis
• Inflamed Meckel’s diverticulum
• Functional bowel disease

Question 6

What investigations are carried out for appendicitis?

Answer 6

• FBC - mild Leucocytosis
• CRP - elevated, lags behind clinical signs
• Amylase - normal, to exclude pancreatitis
• U&E’s - normal, to exclude UTI and AKI
• Urinalysis - normal; to exclude UTI
• Urine Culture - normal; to exclude UTI
• Pregnancy Test
• AXR - not usually diagnostic. Enlarged appendix
• Abdominal Ultrasound - not usually diagnostic. Enlarged appendix.
• CT Abdomen and Pelvis - not usually done; enlarged appendix. Delay could be fatal
• Surgical laproscopy

Question 7

What is the management for appendicitis?

Answer 7

General:
• Rehydration with IV fluids
• Broad-spectrum antibiotics pre-operatively.

Surgical:
• Appendectomy
• AB: ciprofloxacin, cefuroxime, metronidazole

Post-Op –Antibiotics:
• Piperacillin/ Tazobactam for 48 hours if operated on early.
*If gangrenous or perforated: 7-10 days.

Appendix Abscess:
• Drainage must be performed percutaneously under the guide of USS

Question 8

What are the complications of appendicitis?

Answer 8

• Inflammatory mass
• Appendix abscess
• Perforation and peritonitis
• Portal pyemia: septicaemia that leads to widespread abscesses of a metastatic nature.