Appendicitis**** Flashcards
Pathophysiology
Inflammation of vermiform appendix secondary to a faecolith obstruction with subsequent bacterial overgrowth (e.g. E. coli)
Symptoms:
What is the first sign? Then what is it followed by?
Abdo pain
- Character
- Radiation
Anorexia then abdo pain then vomiting
Visceral colicky pain in the umbilical region then moves to RIF and becomes constant.
Symptoms:
What indicates RIF peritonism?
What indicates an abscess has formed or perforated?
Pain on moving or coughing
Guarding
Rebound tenderness
A high fever
What are the 4 signs of appendicitis that can be precipitated?
McBurney’s sign
Rovsing’s sign
Psoas sign
Obturator sign
Signs of acute appendicitis:
What is McBurney’s sign?
What is Rovsing’s sign?
What is the Psoas sign? - look at pics
What is the Obturator sign? - look at pics
1/3 of the way between right ASIS and umbilicus is extremely tender
RIF pain on pressing the LIF
Pain on extending the hip (if retrocecal appendix) (extending = moving leg behind them)
Pain on flexion and internal rotation of the right hip
What may happen if it is left untreated? - 3
What can adhere to the appendix causing an appendix mass?
Perforation
Generalised peritonitis
Abscess formation
Small bowel and Omentum (a fold of peritoneum connecting the stomach with other abdominal organs.)
Investigations:
Bloods - 2 things you look for?
What might be found in the urine?
What is the gold standard imaging tool and what does it prevent?
FBC - Raised WBC
Raised CRP
White cells
Abdo-pelvis CT
Management:
Surgery - appendectomy:
- What type of appendectomy is used in pregnancy?
What should be given before surgery and 24 hrs after?
What happens with most cases of uncomplicated appendicitis?
Appendectomy
Open as safer - done through the McBurnleys point
Antibiotics IV
Resolve with ABs but surgery performed due to risk of recurrence.
Management of complications:
- Abscess
- Appendix mass
IV antibiotics and CT-guided drainage
Antibiotics initially then appendectomy when settled
