Appendicitis Flashcards
Define
Sudden inflammation of the appendix usually initiated by obstruction of the lumen
Epidemiology
The MOST COMMON surgical emergency
Can occur at any age
Most commonly occurs between 10-20 yrs
Causes
Gut organisms invade the appendix wall after lumen obstruction (e.g. by lymphoid hyperplasia, faecolith or filarial worms)
This leads to oedema, ischaemic necrosis and perforation
Risk Factors
?Hygiene hypothesis – there may be an impaired ability to prevent invasion, brought about by improved hygiene and less exposure to pathogens
Symptoms
Periumbilical pain that moves to the right iliac fossa
Anorexia is an important feature
Vomiting (may occur after pain)
Constipation
Diarrhoea
Signs
General Signs
- Tachycardia
- Fever
- Furred tongue
- Lying still
- Coughing hurts
- Foetor with/without flushing
- Shallow breaths
RIF Signs
- Guarding
- Rebound and percussion tenderness
- PR pain on the right side (sign of low-lying pelvic appendix)
Special Signs
- Rovsing’s Sign - palpation of the left iliac fossa causes more pain in the right iliac fossa than the left
- 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)
Investigations
Bloods
High WCC (mainly neutrophils)
High CRP
Ultrasound may help
CT - high diagnostic accuracy
Management
Prompt appendicectomy
Antibiotics:
Cefuroxime
Metronidazole
Laparoscopy - diagnostic and therapeutic advantages
Complications
Perforation
Appendix mass
- Occurs when the inflamed appendix becomes covered with omentum
Appendix abscess
- May occur if appendix mass fails to resolve
- Treatment involves drainage and antibiotics
Prognosis
Uncomplicated appendicitis - most people recover with no long-term problems
Ruptured appendix - greater risk of complications/death
