General: Acute Appendicitis

Question 1

What is the pathophysiology of an acute appendicitis?

Answer 1

Inflam of the appendix

Question 2

What are the causes of an acute appendicitis?

Answer 2

Faecolith = stony mass of faeces

Lymphoid hyperplasia

Impacted stool

Caecal tumour

Question 3

How does an acute appendicitis present?

Answer 3

Abdominal pain = initially dull peri-umbilical localising to the RIF (sharp)

Vomiting

Anorexia

Nausea

Diarrhoea

Constipation

Tachycardia

Tachypnoeic

Pyrexia

Rebound tenderness

Percussion pain over McBurney’s point

Guarding = if perforated

Question 4

Where is McBurneys point?

Answer 4

two thirds of the way between the umbilicus and the ASIS

Question 5

What are the textbook signs of an acute appendicitis?

Answer 5

Rovsing’s sign: RIF fossa pain on palpation of the LIF

Psoas sign: RIF pain with flexion of the right hip (inflamed appendix abutting psoas major muscle in a retrocaecal position)

Question 6

How should a suspected acute appendicitis be investigated?

Answer 6

Urinalysis = exclude UTI, renal, urological cause

Pregnancy test

Routine bloods = FBC, CRP

Pelvic exam in females of reproductive age = gynaecological pathology

Trans-abdominal US = most useful in children (less abdo fat)

CT scan = used in older pts

Question 7

How should an acute appendicitis be managed?

Answer 7

Laparoscopic appendicectomy = appendix sent to histopathology

Question 8

What are the possible complications of an acute appendicitis?

Answer 8

Perforation = peritoneal contamination

Surgical site infection

Appendix mass = where omentum and small bowel adhere to the appendix

Pelvic abscess = fever with a palpable RIF mass, CT, Abx, percutaneous drainage of abscess

Question 9

How long would you recommend a pt with appendicitis refraining from driving?

Answer 9

Normal activities can resume in a few days but full recovery can take up to 4-6 weeks during which time strenuous activity should be avoided