Gen Surg: Appendicitis

Question 1

What are differentials of right iliac fossa pain?

Answer 1

acute appendicitis, mesenteric adenitis, crohns, diverticulitis (but usually on the left), inflamed Meckel’s diverticulum, ovarian torsion, ectopic pregnancy, ovarian cyst, testicular torsion, pyelonephritis, ureteric colic

Question 3

What is a RF for appendicitis?

Answer 3

In 20s-30s. FHx. Caucasian. Seasonal RF - summer.

Question 4

How does appendicitis present?

Answer 4

Generalised peri-umbilical pain which later localises in the RIF. Vomiting, nausea, diarrhoea/constipation,

Question 5

What is found on examination of a pt with appendicitis?

Answer 5

Guarding, rebound tenderness, percussion over McBurney’s point. Rovsing’s sign - pain in RIF when palpate LIF. Psoas sign - RIF pain with extension of the right hip.

Question 6

Name four investigations you might do for suspected appendicitis

Answer 6

Urinalysis - check pregnancy and urological causes. Bloods - FBC, U+Es, CRP, serum beta-hCG.
US and CT, laparoscopic investigation.

Question 7

How is appendicitis managed?

Answer 7

Laparascopic appendectomy, open appendectomy with a Lanz incision. Appendix to be sent to histopathology to look for malignancy. May need abs and percutaneous drainage. Analgesia.

Question 8

Name a complication of appendicitis

Answer 8

Perforation. Surgical site infection. Abscess formation.

Question 9

Differentials for generalised acute abdominal pain?

Answer 9

Peritonitis
Ruptured AAA
Intestinal obstruction
Ischaemic colitis

Question 10

Differentials for periumbilical pain?

Answer 10

Ruptured AAA
Intestinal obstruction
Ischaemic colitis
Early sign of appendicitis

Question 11

RIF pain - differentials?

Answer 11

Acute appendicitis
Ectopic pregnancy
Ruptured ovarian cyst
Ovarian torsion
Meckel’s diverticulum

Question 12

contraindications to laprascopic surgery

Answer 12

Absolute contraindications:
- haemodynamic instability/shock
- raised intracranial pressure
- acute intestinal obstruction (i.e. dilated bowel loops (e.g. > 4 cm)
- uncorrected coagulopathy

Relative contraindications:
- cardiac or respiratory failure
- recent laparotomy (within 4-6 weeks)
- abdominal aortic aneurysm (increased risk of vascular rupture)
- pregnancy (risk of injury to uterus)
- extensive adhesions from previous bowel surgery

Question 13

complications of laprascopic surgery

Answer 13

include:

• general risks of anaesthetic
• vasovagal reaction (e.g. bradycardia) in response to abdominal distension
• extra-peritoneal gas insufflation: surgical emphysema
• injury to gastro-intestinal tract
• injury to blood vessels e.g. common iliacs, deep inferior epigastric artery