Appendicitis

• What is appendicitis?


  Inflammation of the appendix
• What is the peak incidence of appendicitis?

  10-20 yrs
• Pathophys - appendicitis


  Pathogens become trapped in appendix (due to obstruction at the point where appendix meets bowel) -> infection & inflammation -> may proceed to gangrene & rupture

  Rupture -> faecal contents & infective material are released into peritoneal cavity -> peritonitis
• What are the RFs of appendicitis?

  Frequent use of antibiotics

  Imbalance of gastrointestinal microbial flora

  Smoking
• What are the signs & symptoms of appendicitis?

  Abdo pain (typically starts central -> moves down to right iliac fossa -> McBurney's point)

  Loss of appetite

  Nausea & vomiting

  Low grade fever

  Rovsing's sign (palpation to left iliac fossa causes pain in RIF)

  Guarding on abdo palpation

  Rebound tenderness in RIF (peritonitis)

  Percussion tenderness (peritonitis)
• What is McBurney's point?

  1/3 of the distance from ASIS to umbilicus
• What are the Inx of appendicitis?

  Obs

  Full Hx & examination

  Urine dip & MSU

  Pregnancy test

  Bloods (FBC, LFTs, CRP, hCG)

  Abdominal USS

  Abdominal CT
• What are the key DDx of appendicitis?

  Ectopic pregnancy

  • consider in all females of childbearing age
  • serum of urine hCG

  Ovarian cysts

  Meckel's diverticulum

  • can cause volvulus or intussusception

  Mesenteric adenitis

  • usually in younger children
• When does an appendix mass occur? How is it managed?

  Omentum surrounds & sticks to the inflamed appendix -> mass in right iliac fossa

  Conservative management -> support & Abx, then appendicectomy once acute condition is resolved
• What is the management of appendicitis?

  Suspected appendicitis = emergency hospital admission under surgical team

  Prophylactic IV Abx (or full sepsis 6 is appropriate)

  Appendicectomy
• What are the possible complications of an appendicectomy?

  Bleeding, infection, pain & scars

  Damage to bowel, bladder or other organs

  Removal of a normal appendix

  Anaesthetic risks

  VTE
• What are the possible complications of appendicitis?

  Local abscess formation

  Perforation

  Gangrene

  Postoperative wound infection

  Peritonitis