Appendicitis

Question 1

What causes appendicitis?

Answer 1

Obstruction: fecalith, seeds, pinworm infections, lymphoid hyperplasia

Question 2

What occurs if the appendix ruptures?

Answer 2

Peritonitis- rebound tenderness abdominal guarding

Abscess (periappendical)

Question 3

What is acute appendicitis pathology?

Answer 3

1/6th population affected
Appendix obstructed by a faecolith/foreign body, or lymphoid enlargement in the wall
Can follow URTI
Bacteria proliferate in closed bowel loop –> necrosis & perforation due to raised intraluminal pressure

Question 4

Acute appendicitis symptoms

Answer 4

Dull central –> sharp localised RIF pain (McBurney’s point)
Constipation/diarrhoea
Anorexia
Nausea + vomiting after pain

Question 5

Acute appendicitis signs

Answer 5

Rebound tenderness in RIF
Percussion tenderness
Guarding
Rosving’s sign (RIF more painful than LIF)
PR painful on right
Tachycardia
Mild fever, flushing and fetor
Tender mass (ocassionally)
Psoas sign: pain on right hip extension: retroperitoneal retrocaceal appendix
Obturator sign: pain on internal rotation of right hip: pelvic appendix

Question 6

Examples of appendicitis which may be difficult to diagnose

Answer 6

Infants with D+V
Children: vague abdominal pain
Females: presenting with gynaelogical issues
Confused elderly

Question 7

Acute appendicitis investigations

Answer 7

PR
Pelvic exam in females 
Pregnancy test 
Bloods: FBC, U&E, CRP/ESR 
Urinalysis 
USS/CT: if diagnostic uncertainty 
AXR/erect CXR: if questioning perforation

Question 8

Complications of a perforated appendix

Answer 8

Peritonitis & sepsis
Appendix mass: inflamed appendix becomes covered with omentum
Appendix abscess: local, pelvic, subhepatic, subphrenic
Adhesions
Infertility: tubal obstruction after pelvic infection

Question 9

Causes of a mass in the RIF

Answer 9

Inflammatory: appendix
Lymphoma 
Crohn's 
Tumour: caecal/carcinoid 
Pelvic kidney