Gen Surg: Appendicitis Flashcards
What is acute appendicitis?
https://www.youtube.com/watch?v=r9amif1DQMc
A common surgical emergency that is caused by inflammation of the appendix
What is the pathogenesis of acute appendicitis?
Gut organisms invade the appendix wall after lumen obstruction by lymphoid hyperplasia, faecolith or filarial worms. There is inflammation of the vermiform appendix.
This leads to oedema, ischaemic necrosis and perforation.
What is the most common cause of appendicitis?
Faecolith - hard mass of faecal matter
What are main causes of obstruction of the appendix?
- Faecolith
- Normal stool
- Lymphoid hyperplasia
What are the three types of appendicitis?
- Mucosal - mildest form
- Phlegmonous - Slow onset and relatively slow progression
- Necrotic - often due to acute bacterial infeciton with ischaemic necrosis - leads to perforation
What are symptoms of appendicitis?
- Periumbilical pain that moves and localises to to RIF (inflammation of overlying peritoneum). Worse on movement.
- Anorexia (loss of eppetitie for food)
- Constipation (more often)/diarrhoea
What are signs of appendicitis?
- Tachycardia
- Fever (mild)
- Peritonism - guarding, rebound tenderness, percussion tenderness in RIF
- Rovsig’s sign
- Murphy’s Sign
- Psoas sign
- Obturator sign
What is the obturator sign?
Pain on internal rotation of the thigh.
What is the mechanism behind the obturator sign?
The inflamed appendix lies in contact with the obturator internus muscle. When the leg is rotated, the obturator moves and the appendix is stretched and irritated.
What is Mcburney’s point tenderness?
A point of maximum tenderness on palpation located one-third of the distance from the right anterior superior iliac spine to the umbilicus
What condition(s) is Mcburney’s Point associated with?
Appendicitis
What is the mechanism behind the presentation of Mcburney’s point tenderness?
McBurney’s point is said to be the most common surface location of the appendix.
When the appendix becomes inflamed such that it is no longer in the lumen of the bowel the peritoneum becomes locally irritated and tender.
What is Rovsing’s sign?
When the left lower quadrant is palpated, the patient feels pain in the right lower quadrant
What is rovsing’s sign caused by?
Traditionally appendicitis; although theoretically inflammation of any organ in the right lower quadrant may elicit Rovsing’s sign.
What is the psoas sign?
The patient experiences pain on passive extension of the thigh
What is the mechanism behind the psoas sign?
If the appendix is in a retro-caecal position, it may be in contact with the psoas muscle. Therefore, movement of this muscle will irritate the inflamed appendix, causing pain. A similar process occurs with a psoas abscess.
How would you manage someone with acute appendicitis?
Confirm diagnosis - primarily clinical diagnosis
- ABCDE - manage sepsis
- Antibiotics - avoid giving without clear diagnosis
-
Appendicectomy
- Open
- Laparoscopic
- Abdominal lavage in pateitns with perforation
What antibiotic therapy would you consider using in someone with acute appendicitis?
3-7 days
- IV Gentamicin + Metranidazole +/- amoxicillin (if pen allergic -> Co-trimoxazole)
- Switch to oral Metranidazole and either Doxycyline/Co-trimoxazole
