Appendicitis – Zero To Finals

The appendix is a small, thin tube of bowel sprouting from the caecum
Appendicitis is inflammation of the appendix
Results from obstruction of the appendix and subsequent infection and inflammation of the appendix
Peak incidence in ages 10-20

Tender to McBurney’s point (1/3 the distance from the ASIS to umbilicus)
Guarding to RIF
Rebound tenderness (increased pain when releasing deep palpation to the RIF) and percussion tenderness indicate peritonitis
Rovsing’s sign (palpation of the left iliac fossa (LIF) causes pain in the RIF)

Diagnosis is mostly clinical based on signs and raised inflammatory markers
CT can be useful in confirming diagnosis in confirming the diagnosis, particularly where other diagnosis more likely
USS can be useful in women to exclude ovarian and gynae pathology
If clinically appendicitis but tests are negative may proceed to diagnostic laparoscopy – appendicectomy

Ectopic pregnancy (in women of childbearing age)
- Gynecological emergency with relatively high mortality if mismanaged
- Essential to get a serum bHCG to exclude pregnancy / ectopic
Ovarian cysts (with torsion or rupture)
Meckel’s diverticulitis
- Malformation of the distal ileum in 2% of the population
- Can become inflamed and infected in the same way as the appendix
Mesenteric Adenitis (usually in younger patients)
- Abdominal pain caused by inflamed abdominal lymph nodes
- Often associated with cough/cold
- No treatment required

Signs of appendicitis with palpable mass in RIF
When the omentum and / or bowel surround and stick to the inflamed appendix
Typically managed conservatively with supportive treatment and antibiotics, with appendicectomy once acute condition has resolved