Appendicitis

Question 1

Definition of appendicitis

Answer 1

Inflammation of the vermiform appendix

Question 2

Aetiology + Risk factors of appendicitis

Answer 2

Obstruction of the lumen of the appendix
Main causes - faecolith, normal stool or lymphoid hyperplasia

RF: low dietary fibre, smoking

Question 3

Epidemiology of appendicitis

Answer 3

Most common acute surgical abdominal emergency
Predominantly males 15-59
Incidence lower in populations with high-fibre diet

Question 4

Presenting symptoms of appendicitis

Answer 4

Abdominal pain: umbilical region -> RIF, acute, constant with intermittent cramps, worse on movement and cough 
Anorexia
N+V
Loose stool
Constipation

Question 5

What are the following regions of pain associated with in appendicitis: flank/back, testicular, suprapubic

Answer 5

Flank or back pain - retrocaecal appendix
Testicular pain - retroileal appendix
Suprapubic pain - pelvic appendix

Question 6

Signs of appendicitis on examination

Answer 6

Pain, RLQ tenderness
Rebound tenderness
Hypotension and tachycardia 
Palpable mass
Peritonitis: guarding and patient is still
Low-grade pyrexia 
Flushed face
Reduced bowel sounds 
Rovsing's sign
Cope's sign
Psoas sign (retrocaecal appendix)

Question 7

Investigations for appendicitis

Answer 7

Raised WCC + CRP + clinical picture -> warranties appendicectomy

Abdominal USS: aperistaltic or non-compressible structure (outer diameter >6mm)

Urinalysis: rule out UTI
Pregnancy test: negative

FBC: leukocytosis
CRP: elevated
G+S: for surgery

CT abdomen: abnormal appendix, diameter >6mm, calcified appendix

Question 8

Management of appendicitis if uncomplicated and fit for surgery

Answer 8

Supportive treatment:
NBM if vomiting (try to keep enteral feeding)
Analgesia (paracetamol 15mg/kg IV)

Appendicectomy (lap)

Question 9

Management of appendicitis if uncomplicated and unfit for surgery

Answer 9

Supportive treatment:
NBM
Analgesia e.g. paracetamol 15mg/kig IV every 4-6 ho
Antibiotics : Amoxicillin 500mg IV every 8 hours AND metronidazole 500mg IV every 8 hours

Question 10

Management of appendicitis if there is free perforation

Answer 10

Supportive treatment:
NBM
Analgesia e.g. paracetamol 15mg/kig IV every 4-6 ho

Appendicectomy

Antibiotics : Amoxicillin 500mg IV every 8 hours AND metronidazole 500mg IV every 8 hours

Question 11

Complications of appendicitis

Answer 11

Perforation
Peritonitis
Appendicular mass or abscess
Surgical wound infection

Question 12

Prognosis for appendicitis

Answer 12

Good if treated well

Laparoscopic appendicectomy has been shown to decrease the incidence of overall complications