Appendicitis

Question 1

What is appendicitis?

Answer 1

inflammation of the appendix

Question 2

Summarise the epidemiology of appendicitis

Answer 2

MOST COMMON surgical emergency
Can occur at any age
Most common: 10-20 yrs

Question 3

Explain the aetiology of appendicitis

Answer 3

Gut organisms invade the appendix wall after lumen obstruction (e.g. by lymphoid hyperplasia, faecolith or filarial worms)
Leads to oedema, ischaemic necrosis + perforation

Question 4

List 5 presenting symptoms of appendicitis

Answer 4

Periumbilical pain that moves to RIF
Anorexia
Vomiting (may occur after pain) 
Constipation 
Diarrhoea

Question 5

List 7 general signs of appendicitis on physical examination

Answer 5

Tachycardia 
Fever  
Furred tongue  
Coughing hurts  
Foetor 
Shallow breaths
Lying still

Question 6

What are 3 RIF signs in appendicitis?

Answer 6

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

Question 7

What are the special signs of appendicitis seen on physical examination?

Answer 7

Rovsing’s Sign: palpation of LIF causes more pain in RIF
Psoas Sign: pain on extending hip (caused by retrocaecal appendix)
Cope Sign: pain on flexion + internal rotation of hip (occurs if appendix in close proximity to obturator internus)

Question 8

List 4 variations in clinical picture in appendicitis

Answer 8

Inflammation of retrocaecal/ retroperitoneal appendix may cause flank pain or RUQ pain
Only sign may be tenderness on right on DRE
Child may have vague abdo pain + won’t eat their favourite food
Shocked confused 80+, not in any pain

Question 9

What are the appropriate investigations for peritonitis?

Answer 9

Bloods: High WCC (mainly neutrophils) + High CRP
USS
CT: high diagnostic accuracy

Question 10

Generate a management plan for appendicitis

Answer 10

Prompt appendicectomy
Abx: Cefuroxime + Metronidazole
Laparoscopy: diagnostic + therapeutic advantages

Question 11

List 3 possible complications of appendicitis

Answer 11

Perforation
Appendix mass: inflamed appendix becomes covered with omentum
Appendix abscess: if appendix mass fails to resolve, tx involves drainage + abx

Question 12

What is the prognosis for patients with appendicitis ?

Answer 12

Uncomplicated appendicitis: most recover with no long-term problems
Ruptured appendix: greater risk of complications/ death