Appendicitis Flashcards
What is appendicitis?
The appendix becomes inflamed due to infection trapped in the appendix by obstruction at the point where the appendix meets the bowel.
When does appendicitis typically present?
10-20yrs
What are the abdominal features of appendicitis?
- Peri-umbilical abdominal pain radiating to right iliac fossa
- Pain worse on coughing or going over speed bumps
What causes the initial peri-umbilical abdominal pain?
Visceral stretching of appendix lumen and appendix is midgut structure
What causes the radiation to the right iliac fossa?
Localised parietal peritoneal inflammation
What are the other features of appendicitis?
- Occasional vomiting
- Mild pyrexia is common
- Anorexia
What are the signs on examination?
- Guarding on abdominal palpation
- Rebound tenderness
- Percussion tendernessn
- Rovsing’s sign (palpation in the LIF causes pain in the RIF)
- Tenderness at McBurney’s point
What do rebound and percussion tenderness suggest?
Peritonitis, caused by a ruptured appendix
How do you diagnose appendicitis?
• Raised inflammatory markers with compatible history and examination findings
• Urinalysis
o Exclude pregnancy, UTI and renal colic
• US
o Excludes ovarian and gynaecological pathology
How do you manage appendicitis?
- Appendicectomy
* Prophylactic IV antibiotics
What are the differentials of appendicitis?
- Ectopic pregnancy
- Ovarian cysts
- Meckel’s diverticulum
- Mesenteric adenitis
- Appendix mass
How do you rule out an ectopic pregnancy?
- bHCG
What are the features of Meckel’s diverticulum?
o Malformation of distal ileum
o Can become inflamed, rupture or cause a volvulus or intussusception
What are the features of Mesenteric adenitis?
o Inflamed abdominal lymph nodes
o Presents as abdominal pain, usually in younger children
o Often associated with tonsilitis or URTI
What is an appendix mass?
Omentum surrounds and sticks to the inflamed appendix
