Appendicitis

Question 1

Pathogenesis of acute appendicitis

Answer 1

1) Obstruction: Faecolith (most common)
2) Infection behind obstruction
3) Oedema –> Ischaemia –> Necrosis –> Perforation

Question 2

Pain in appendicitis

Answer 2

Early: Umbilical (T10/11) lesser splanchnic nerve

Late: RIF pain (peritonitic)

Question 3

Symptoms of appendicitis

Answer 3

Colicky abdo pain worse on movement

Anorexia

Nausea

Constipation/diarrhoea

Question 4

Signs of acute appendicitis

Answer 4

Signs of infection (temp, raised HR)

Pain and guarding

McBurney’s point

Question 5

Rovsing’s sign

Answer 5

Acute Appendicitis:Pressure in LIF leads to pain in RIF

Question 6

Psoas Sign

Answer 6

Acute Retrocaecal appendix:

Pain on extending hip

Question 7

Cope sign

Answer 7

Acute appendicitis close to obturator internus:

Pain on Flexion + Internal rotation of R hip

Question 8

Differential diagnoses of acute appendicitis

Answer 8

Cholecystitis

Diverticulitis

Meckel’s Diverticulum

Ruptured ectopic

Salpingitis

UTI

Crohn’s

Mesenteric adenitis

Question 9

Investigations for appendicitis

Answer 9

Bloods: FBC, CRP, amylase

Urine: B-HCG (ectopic)

Imaging: Ultrasound or CT

Diagnostic laparoscopy

Question 10

Treatment of acute appendicitis

Answer 10

Fluids

Ceftriaxone and Metronidazole

Analgaesia

Appendectomy (open or laparoscopic)

Question 11

Complications of acute appendicitis

Answer 11

Appendix abscess

Perforation

Question 12

Significance of retrocaecal appendix

Answer 12

Pain does not migrate to RIF

Therefore often detected late