Appendicitis

• Pathophys - appendicitis


  Infection trapped in appendix by obstruction where appendix meets bowel (fibrous tissue, foreign body, hardened mass of stool (faecolith))-> inflammation -> can quickly proceed to gangrene & rupture -> release of infective material & faecal content into abdomen -> peritonitis
• What are the signs & symptoms of appendicitis?

  Pain (periumbilical -> R iliac fossa -> McBurney's point)

  Nausea

  Vomiting

  Anorexia (loss of appetite)

  Change in bowel habits

  Fever

  Tachycardia

  Rovsing's sign (palpation of L iliac fossa -> pain in R iliac fossa)

  Guarding on abdo palpation

  Rebound tenderness (peritonitis)

  Percussion tenderness (peritonitis)
• What are the DDx of appendicitis?


  Ectopic pregnancy (consider in any F of childbearing age)

  Ovarian cysts

  Meckel's diverticulum

  Mesenteric adenitis

  Appendix mass
• What is Meckel's diverticulum?


  Malformation of distal ileum

  Usually asymptomatic

  Can become inflamed, rupture or cause a volvulus or intussusception
• What is mesenteric adenitis?


  Inflamed abdominal lymph nodes

  Usually presents in younger children

  Often associated with tonsillitis or URTI
• What are the Inx for appendicitis?

  Obs

  Full Hx & examination

  VBG

  Pregnancy test

  Urine dip

  Bloods (FBC, U&Es, LFTs, CRP, amylase, coag, group & save, cultures (if ?sepsis))

  CXR

  CT abdo & pelvis

  USS of R iliac fossa
• When is imaging used in appendicitis?

  Generally only used when there is doubt in diagnosis or to rule out DDx

  Acute appendicitis is primarily a clinical diagnosis
• What is the management of appendicitis?


  Surgery -> laparoscopic appendicectomy (1st line)

  Prophylactic Abx
• What are the possible complications of appendicectomy?

  Bleeding

  Infection

  Pain

  VTE
• What are the possible complications of appendicitis?


  Local abscess formation

  Perforation

  Gangrene

  Postoperative wound infection

  Peritonitis
• Without causing pain to the child via palpation, how else can you see if there is appendicitis?

  Asking child to hop -> this will cause the appendix to move & touch the peritoneum = pain
• What scoring system can be used in appendicitis?


  Alvarado Score