Appendicitis and Peritonitis Flashcards
Pathophysiology of appendicitis
- lymphoid hyperplasia or a faecolith cause direct luminal obstruction
- gut organisms invade the appendix wall → inflammation
- leads to oedema, ischaemia +/- perforation
How does appendicitis present?
- Abdominal pain
- Tenderness in McBurney’s point
- Loss of appetite (anorexia)
- Nausea and vomiting
What is the location of McBurney’s point and what is its significance?
Located ⅓ of the distance from the ASIS to the umbilicus
Pain in appendicitis typically starts at the umbilicus and migrates towards McBurney’s point (central to RIF)
Features of appendicitis on examination
- Rovsing’s sign
- Guarding on abdominal palpation
- Rebound tenderness
- Percussion tenderness
What is Rovsing’s sign?
Palpation of the left iliac fossa causes pain in the RIF
What is rebound and percussion tenderness
What do these indicate in suspected appendicitis?
- Rebound: increased pain when quickly releasing pressure on RIF
- Percussion: pain on percussing abdomen
Both suggest peritonitis, caused by a ruptured appendix
Why is appendicitis and medical emergency?
Can quickly proceed to gangrene and rupture
if it ruptures, it releases faecal content and infective material into the abdomen → peritonitis
How is appendicitis diagnosed?
Clinical presentation and raised inflammatory markers
CT scan to confirm diagnosis
What scoring system exists for appendicitis?
Alvarado
7+ out of 10 indicates appendicitis]
List 4 key differentials for appendicitis
- Ectopic Pregnancy
- Ovarian Cysts
- Meckel’s Diverticulum
- Mesenteric Adenitis
- Appendix Mass
Management of appendicitis?
Appendicectomy
List 3 complications of untreated appendicitis
- Local abscess
- Perforation
- Gangrene
List 4 complications of an appendectomy?
- Bleeding, infection, pain and scars
- Damage to bowel, bladder or other organs
- Removal of a normal appendix
- Anaesthetic risks
- VTE or PE
What are the 2 main categories of peritonitis?
- Spontaneous bacterial peritonitis
- Secondary peritonitis (ie. perforation of an organ)
List 4 causes of peritonitis
- Boerhaave syndrome
- Perforated duodenal/gastric ulcer
- Perforation 2o to appendicitis, diverticulitis, IBD
- Spontaneous bacterial peritonitis
What is the key manifestation of peritonitis
Acute abdominal pain
List 4 signs of peritonitis on examination
- Abdominal rigidity / involuntary abdominal guarding
- Rebound tenderness
- Fever, vomiting, tachycardia and hypotension
SBP most commonly occurs in which patients?
Patients with ascites secondary to liver cirrhosis
List 3 features of SBP
- ascites
- abdominal pain
- fever.
How is a diagnosis of SBP made?
Paracentesis: neutrophil count > 250 cells/ul
Most common causative organism on ascitic fluid culture in SBP?
E. coli
Management of SBP?
IV cefotaxime
In patients with ascites, who is antibiotic prophylaxis offered too?
- Previous episode of SBP
- Fluid protein <15 g/l and either a Child-Pugh score of at least 9 or hepatorenal syndrome
What organism is the most common cause of peritonitis in Peritoneal dialysis?
Coagulase-negative staphylococci ie. Staph epidermidis
Most worrying complication of peritonitis?
Sepsis
