GI - appendicitis

Question 1

Hx: 18 year old pt presents with anorexia first, then abdo pain +/- V, +/- C. Pain was visceral colicky pain in periumbilical region, moved to RIF and became constant, has pain on moving or coughing?

Ex: (peritonism)
● guarding, rebound tenderness
● fever + ↑ HR
● percussion tenderness localised to 1/3 of the way between the right ASIS and umbilicus (McBurney’s)
● RIF pain on pressing LIF (Rosving’s)
● pain on flexion and internal rotation of the right hip (cope/obturator)
● pain on extending hip /on right side during PR (if retrocecal)

Answer 1

appendicitis!

remember pain usually precedes V

Question 2

pain localised to 1/3 of the way between the right ASIS and umbilicus?

Answer 2

McBurney’s point

Question 3

RIF pain on pressing LIF?

Answer 3

Rosving’s sign (appendicitis)

Question 4

pain on extending hip?

Answer 4

Psoas sign

Question 5

pain on flexion and internal rotation of the right hip?

Answer 5

Cope/Obturator sign (appendicitis)

Question 6

complications of appendicitis?

Answer 6

● perforation
● generalised peritonitis
● abscess
● small bowel adherence

Question 7

Ix appendicitis?

Answer 7

● clinical diagnosis
● bloods:
- ↑wbc, CRP
● urine
- pregnancy test!
\+/- wbc
● A-P CT is best imaging (often not required)

Question 8

Tx appendicitis?

Answer 8

● surgery: appendectomy (lap has fewer complications)
● open if pregnant
● Abx IV before and 24hrs after

Question 9

ΔΔ appendicitis?

Answer 9

ask about gynae
● salpingitis/PID
● dysmenorrhoea
● ectopic (do a test!)

ask about urine
● UTI (urinalysis)
● cystitis

if in kids (rare < 2 yrs)
● mesenteric adenitis (recent viral/lymph)
● Meckel’s diverticulum

ask about fatty meal/pain after food
● cholecystitis
● perforated ulcer

ask about bowel habit
● diverticulitis
● Crohn’s disease
● food poisoning

Question 10

how can present in kids?

Answer 10

won’t eat their favourite food and abdo pain

use their hand to press their tummy

Question 11

how may present in pregnancy?

Answer 11

less localised

Question 12

tip for Ex?

Answer 12

don’t start with palpating RIF (makes it hard to elicit pain elsewhere)