Appendicitis Flashcards
What is the appendix?
small, thin tube of bowel sprouting from the caecum
What causes appendicitis?
Results from obstruction of the appendix and subsequent infection and inflammation of the appendix
Peak incidence
ages 10-20
Symptoms
- Abdominal pain, typically central then settling in the right iliac fossa (RIF)
- Loss of appetite (anorexia), nausea and vomiting.
Signs
- Tender to McBurney’s point (1/3 the distance from the ASIS to umbilicus)
- Guarding to RIF
- Rebound tenderness (increased pain when releasing deep palpation to the RIF) and percussion tenderness indicate peritonitis
- Rovsing’s sign (palpation of the left iliac fossa (LIF) causes pain in the RIF)
Diagnosing
- Diagnosis is mostly clinical based on signs and raised inflammatory markers
- CT can be useful in confirming diagnosis in confirming the diagnosis, particularly where other diagnosis more likely
- USS can be useful in women to exclude ovarian and gynae pathology
- If clinically appendicitis but tests are negative may proceed to diagnostic laparoscopy – appendicectomy
Differentials
•Ectopic pregnancy (in women of childbearing age) ◦Gynecological emergency with relatively high mortality if mismanaged
◦Essential to get a serum bHCG to exclude pregnancy / ectopic
•Ovarian cysts (with torsion or rupture)
•Meckel’s diverticulitis ◦Malformation of the distal ileum in 2% of the population
◦Can become inflamed and infected in the same way as the appendix
•Mesenteric Adenitis (usually in younger patients) ◦Abdominal pain caused by inflamed abdominal lymph nodes
◦Often associated with cough/cold
◦No treatment required
What is an appendix mass?
- Signs of appendicitis with palpable mass in RIF
- When the omentum and / or bowel surround and stick to the inflamed appendix
- Typically managed conservatively with supportive treatment and antibiotics, with appendicectomy once acute condition has resolved
How do you treat appendicitis?
- Definitive management for acute appendicitis
* Laparoscopic is associated with fewer risks and faster recovery versus open
Complications of appendectomy?
◦Bleeding / infection / pain / scars ◦Damage to bowel, bladder or other organs ◦Removal of normal appendix ◦Anaesthetic risk ◦DVT / PE