Appendicitis

Question 1

Define Appendicitis?

Answer 1

Inflammation of the appendix

Question 2

What is the epidemiology of Appendicitis?

Answer 2

The most common surgical emergency
Can occur at any age
Most commonly occurs between 10-20 yrs

Question 3

What is the aetiology of Appendicitis?

Answer 3

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

Question 4

What are the presenting symptoms of Appendicitis?

Answer 4

Periumbilical pain that moves to the right iliac fossa
Anorexia is an important feature 
Vomiting (may occur after pain)
Constipation
Diarrhoea

Question 5

What are the general signs of Appendicitis on physical examination?

Answer 5

Tachycardia
Fever 
Furred tongue 
Lying still 
Coughing hurts 
Foetor with/without flushing 
Swallow breaths

Question 6

What are the RIF signs of Appendicitis?

Answer 6

Guarding
Rebound and percussion tenderness
PR pain on the right side (sign of low-lying pelvic appendix)

Question 7

What are the special signs of Appendicitis on physical examination?

Answer 7

Rovsing’s Sign
Psoas Sign
Cope Sign

Question 8

What is Rovsing’s Sign?

Answer 8

Palpation of the left iliac fossa causes more pain in the right iliac fossa than the left

Question 9

What is the Psoas Sign?

Answer 9

Pain on extending the hip (caused by retrocaecal appendix)

Question 10

What is the Cope Sign?

Answer 10

Pain on flexion and internal rotation of the hip (occurs if the appendix is in close proximity to the obturator internus)

Question 11

What variations in clinical picture will you see with Appendicitis?

Answer 11

Inflammation of retrocaecal/retroperitoneal appendix may cause flank pain or RUQ pain - The only sign may be tenderness on the right on DRE
A child may have vague abdominal pain and will not eat their favourite food
A shocked confused 80+ year old who is not in any pain

Question 12

What investigations would you do for Appendicitis?

Answer 12

Bloods
US
CT

Question 13

What bloods would you do for Appendicitis?

Answer 13

High WCC (mainly neutrophils)
High CRP

Question 14

Why would you do a CT scan for Appendicitis?

Answer 14

High diagnostic accuracy

Question 15

What is the management plan for Appendicitis?

Answer 15

Prompt appendicetomy
Antibiotics:
- Cefuroxime
- Metronidazole

Laparoscopy - diagnostic and therapeutic advantages

Question 16

What are the possible complications of Appendicitis?

Answer 16

Perforation
Appendix Mass
Appendix Abscess

Question 17

When would an Appendix Mass for Appendicitis?

Answer 17

Occurs when the inflamed appendix becomes covered with omentum

Question 18

When would an Appendix Abscess happen in Appendicitis?

Answer 18

May occur if appendix mass fails to resolve

Treatment involves drainage and antibiotics

Question 19

What is the prognosis for patients with Appendicitis?

Answer 19

Uncomplicated Appendicitis - most people recover with no long-term problems
Ruptured Appendix - greater risk of complications/death