GI - Apendicitis Flashcards
Definition
Inflammation of the appendix.
- The appendix is a small, thin tube sprouting from the caecum
Aetiology
The appendix becomes inflamed due to infection trapped in the appendix by obstruction at the point where the appendix meets the bowel.
Signs and symptoms
ABDO PAIN = central that moves down to the right iliac fossa + eventually becomes localised in the RIL
Tenderness at McBurney’s point = 1/3 from ASIS to umbilicus
- Loss of appetite (anorexia)
- Nausea and vomiting
- Rovsing’s sign
- Guarding on abdominal palpation
- Rebound tenderness = increased pain when quickly releasing pressure on the right iliac fossa
- Percussion tenderness
Rovsings sign
Palpation of the left iliac fossa causes pain in the RIF
What is the implication of rebound tenderness + percussion tenderness
Peritonitis by ruptured appendix
Diagnosis
Clinical presentation
Raised inflammatory markers
CT scan
USS = in female Px exclude ovarian + gynae pathology
Px with clinical presentation suggestive of appendicitis but investigations -ve
Next step is…
Diagnostic laparoscopy
Differential diagnosis
Ectopic pregnancy = serum/urine bHCG (preg test) exclude in adolescent girls
Ovarian cysts = pelvic + iliac fossa pain esp in rupture/torsion
Meckel’s diverticulum = malformation of distal ileum -> volvulus or intussusception
Mesenteric adenitis = associated with tonsillitis, or upper resp tract infection
Appendix mass = omentum surrounds and sticks to inflamed appendix = mass in RIF
Management
Emergency appendectomy
- older team e.g 10+ can be managed under adult general surgical teams
Post surgical Complications
Bleeding, infection, pain and scars
Damage to bowel, bladder or other organs
Removal of a normal appendix
Anaesthetic risks
Venous thromboembolism (deep vein thrombosis or pulmonary embolism)
