Appendicitis

Basics

  • 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

 

Symptoms

  • Abdominal pain, typically central then settling in the right iliac fossa (RIF)
  • Loss of appetite (anorexia), nausea and vomiting.

 

Signs

  • 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

  • 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

 

Common Differential Diagnoses

  • 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

 

Appendix Mass

  • 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

 

Appendicectomy

  • Definitive management for acute appendicitis
  • Laparoscopic is associated with fewer risks and faster recovery versus open
  • Complications:
    • Bleeding / infection / pain / scars
    • Damage to bowel, bladder or other organs
    • Removal of normal appendix
    • Anaesthetic risk
    • DVT / PE
WordPress Theme built by Shufflehound. Copyright 2016-2021 - Zero to Finals - All Rights Reserved