Appendix

Question 1

What is an acute appendicitis?

Answer 1

Acute inflammation of the appendix

Question 2

What are causes of acute appendicitis?

Answer 2

Idiopathic 
Obstruction with faecoliths (dehydration) within lumen
Lymphoid hyperplasia
Parasites (very rarely) 
Tumours (rare)

Question 3

What is a faecolith?

Answer 3

Hard stony mass of faeces

Question 4

What is the commonest tumour of the appendix?

Answer 4

Carcinoid

Question 5

What are other tumours of the appendix besides carcinoid?

Answer 5

Appendiceal mutinous neoplasm

Sessile serrate mucosal lesions

Question 6

What are histopathological features of a carcinoid tumour of the appendix?

Answer 6

Crypt of Lieberkuhns

Stains for Chromogran

Question 7

The metastatic risk of carcinoid tumours of the appendix are proportional to?

Answer 7

Size

Question 8

How do you manage a carcinoid tumour of the appendix if it is <1 cm in size?

Answer 8

Appendectomy alone

Question 9

How do you manage a carcinoid tumour of the appendix if it is >2 cm in size?

Answer 9

Complete right hemi

Question 10

What is the pathophysiology of acute papnedicitis?

Answer 10

Acute inflammation (neutrophils) must involve muscle coat - mucosal ulceration serial congestion (exudate) - pus in lumen

Question 11

How does the appendix become inflamed and infected?

Answer 11

Invasion of appendix wall by gut flora

Question 12

What is the epidemiology of acute appendicitis?

Answer 12

Most common in children/young adulthood (another peak in elderly)

Question 13

How are symptoms of acute appendicitis?

Answer 13

Periumbilical pain - moves into RIF
Pain aggravated by movement
Nausea and vomiting, anorexia

Question 14

What is Rovsing’s sign?

Answer 14

Press on left = pain on right

Question 15

What is Psoas’ sign?

Answer 15

Patient tries to keep hip flexed as it lifts inflamed appendix off psoas

Question 16

What is Obturator’s signs?

Answer 16

If appendix is touching obturator interns, flexing the hip internally bitting will cause pain

Question 17

What are signs of acute appendicitis?

Answer 17

Mild pyrexia
Mild tachycardia
Localised RIF pain
Guarding

Question 18

What are complications of acute appendicitis?

Answer 18

Rupture of appendix - faecal matter escape into peritoneal cavity - peritonitis (possibly fatal)
Abscess, fistula sepsis, liver abscess
Small bowel adheres, phlegmonous mass

Question 19

What are investigations for acute appendicitis?

Answer 19

USS for women and kids or CT (if still unsure)
AXR to exclude other causes
Bloods (FBC, CRP, WCC)
Urinalysis
Pregnancy test to exclude ectopic pregnancy

Question 20

How do you treat an acute appendicitis?

Answer 20

Analgesia, antipyretics, theatre antibiotics, appendectomy (best = laprascopic)
Metronidazole and cefuroximide

Question 21

What are features of an appendix mass?

Answer 21

Tachycardia, worsening pain, vomiting or copious NG aspirates (ileus)
Increase in size

Question 22

How do you treat an appendix mass?

Answer 22

Abx +/- operate

Question 23

An appendix abscess is usually?

Answer 23

Delayed and liquidised

Question 24

What are possible complications of an appendix abscess?

Answer 24

Pelvic abscess
Wound infection
Intra-abdominal abscess
Ileus
Respiratory
DVT/PE
Portal pyaemia
Faecal fistula
Adhesions
Right sided inguinal hernia

Question 25

How do you treat an appendix abscess?

Answer 25

Radiological drian