Appendicitis Flashcards
how common is appendicits?
5% of population
what age groups commonly get appendicitis?
2 Peaks – 2nd/3rd decade and elderly
what is the cause of appendicitis?
Obstruction via: o Lymphoid tissue hyperplasia o Faeces o Foreign body o Worms
what is the pathophysiology of appendicitis?
Obstructed appendix acts as a closed loop; bacteria proliferate in the lumen and invade the appendix which is damaged by pressure necrosis
Vascular supply becomes thrombosed causing, gangrene then perforation
what is the blood supply of the appendix?
end-arteries which are branches of the appendicular branch of the ileocolic artery
what is the disease process of appendicitis?
Obstruction – bacterial overgrowth – distension – ischaemia – inflammation - necrosis - perforation
- appendiceal abscess - gangrene
what are the symptoms of appenditicitis?
Pain – periumbilical pain that moves to RIF
Peritonitis – if present, rigidity
Anorexia, Nausea, Vomiting, altered bowel movements
General – tachycardia, fever, furred tongue, lying still, coughing hurts, foetor +/- flushing, shallow breathing
what are the specific signs associated with appendicitis?
- Rebound tenderness at McBurney’s point – relieving pressure elicits pain
- Rosvigs sign – pain in LRQ when LLQ is palpated
- Psoas sign – increased pain during passive extension of right hip
- Obturator sign – pain felt on passive internal rotation of the flexed hip
what investigations can be done for appendicitis?
Blood tests
1st Line USS
2nd Line CT
Urine dipstick
what will the blood tests in appendicitis show?
neutrophil leucocytosis and elevated CRP
what scoring system is used for appendicitis?
alvarado score
what do the different alvarado scores indicate in appendicitis?
o <4 – appendicitis unlikely
o 5-6 – observe
o >7 – operate
what is the management of appendicitis?
- APPENDIECTOMY
* Antibiotics – metronidazole 500mg/8h + cefuroxime 1.5g/8h
what are the differentials associated with appendicitis?
Ectopic, UTI, Mesenteric adenitis, Cystitis, Cholecystitis, Diverticulitis, Salpingitis/PID, Dysmenorrhoea, Crohns, Perforated ulcer, Food poisoning
• Meckel’s diverticulum
