Appendicitis

Question 1

Pathophysiology

Answer 1

Acute inflammation of the appendix due to impacted faecolith, tumour or lymphoid hyperplasia

• lumen fills with mucus
• increased luminal pressure
• reduced blood flow to appendix
• e.coli and bacteroides fragilis multiply
• inflammation and ischaemia

Question 2

Risk factors for appendicitis

Answer 2

Male
Adolescent and young adults (10 - 25 yo)
FHx

Question 3

Symptoms

Answer 3

Peri umbilical or Epigastric pain which migrates to the RIF
Nausea and vomiting
Low grade fever

Question 4

Signs

Answer 4

Rosving’s sign - palpate LIF causes pain in RIF

McBurney’s sign - pain 1/3rd from ASIS to umbilicus

Psoas sign - lie on left side, pain when extending hip with knee extended - irritation of iliopsoas

Rebound tenderness

Guarding

Question 5

Investigations

Answer 5

Abdominal examination 
Obs 
Bloods - FBC, CRP 
Urine dipstick - exclude UTI
Pregnancy test - exclude ectopic 

First line: USS
CT: if USS inconclusive

Question 6

Management

Answer 6

Gold standard: laparoscopic appendicectomy

Prophylactic abx given prior to surgery

Question 7

Complications

Answer 7

Perforation - shock with tense, distended abdomen, guarding and rigidity

Abscess