Appendicitis Flashcards
Define appendicitis?
Inflammation of the appendix
aetiology of appendicitis?
- Gut organisms invade the appendix wall after lumen obstruction
eg. lymphoid hyperplasia - this leads to oedema, ischaemic necrosis and perforation
epidemiology of appendicitis?
- the most common surgical emergency (6% lifetime incidence)
- can occur at any age
- most common between 10-20
presenting complaints of appendicitis?
- Periumbilical pain that moves to the right iliac fossa
- anorexia
- vomiting
- constipation
- diarrhoea
what is mcburneys point?
- this is the point of pain for appendicitis
- (1/3 of the distance from the ASIS to the umbilicus)
what are the general signs of appendicitis on physical examination?
- tachycardia
- fever
- furred tongue
- lying still
- shallow breaths
what are the signs of the right iliac fossa?
- guarding
- rebound and percussion tenderness
- pain on the right during a PR examination
what are specific signs seen with appendicitis?
Rovsing’s Sign - palpation of the LIF causing more pain in the RIF than the LIF
Psoas Sign - pain on extension of the hip
Cope Sign - pain on flexion and rotation of the hip
some potential unusual presentions of appendicitis?
- flank pain or RUQ pain
- child might have vague pain but complete anorexia
- confused elderly person with no pain
- sometimes occurs in pregnancy (this is dangerous)
investigations for appendicitis?
- bloods these will show high WCC, high CRP - pregnancy test for potential ectopic - USS - CT is unnecessary delay
the management plan for appendicitis?
- prompt appendicectomy
- antibiotics
piperacillin/tazobactam - laparoscopy is preferred in women and the obese due to diagnostic and therapeutic advantages
possible complications of appendicitis?
- perforation
- appendix mass
when the inflamed appendix becomes covered with omentum - Appendix abscess
occurs if the appendix mass fails to resolve
mass and abscess can be treated with drainage and antibiotics
what is the prognosis for patients with appendicitis?
uncomplicated - most people recover with no long term problems
ruptured appendix - greater risk of complications and death