Appendicitis

Surgery > General surgery

Background Knowledge 🧠

Definition

An inflammation of the appendix, a small pouch attached to the beginning of the large intestine.

Aetiology

Most commonly due to obstruction of the appendix lumen by faecoliths (hardened stool).

Clinical Features 🌡️

Symptoms

Initial peri-umbilical abdominal pain that later localises to the right iliac fossa.

Associated symptoms: Nausea, vomiting, loss of appetite, and fever.

Signs

Examine for:
- Signs of peritonitis.
- Guarding and rigidity, rebound tenderness.
- McBurney’s point tenderness: Point one-third the distance from the anterior superior iliac spine to the umbilicus.
- Rovsing’s sign: Palpation of the LIF causes pain in the RIF.

Differential Diagnoses

Gastroenteritis
Ectopic pregnancy (in females)
Meckel’s diverticulitis
Urinary tract infections
Nephrolithiasis

Investigations 🧪

Investigations

Full Blood Count (FBC): Elevated white cell count with neutrophilia.

Ultrasound: To visualise the appendix and check for any abscess or mass.
- Potentially more useful in women where alternative pathology is considered more likely

CT scan: Higher sensitivity and specificity than ultrasound, especially in adults.

Urinalysis: To rule out urinary tract infection or nephrolithiasis as differential diagnoses.

Management 🥼

Management

Surgical removal (appendicectomy): Gold standard; can be open or laparoscopic (more common).

Antibiotics: Empirical treatment for bacterial infections. Used both pre-operatively to reduce inflammation and post-operatively.

Pain relief with paracetamol or other suitable analgesics.

Complications

Peritonitis: Inflammation of the inner lining of the abdominal wall due to rupture of the appendix.

Abscess formation: Pus-filled mass inside the appendix or abdomen.

Adhesion: Bands of scar-like tissue that form between abdominal tissues and organs, causing them to stick together.

Sepsis

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Regarding acute appendicitis:

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90.48% of users got this question correct

Answer Explanation:

The correct answer is “Mesenteric adenitis may present in a similar way”. Mesenteric adenitis is a condition characterized by inflammation of the mesenteric lymph nodes in the abdomen. It can mimic the symptoms of acute appendicitis, such as abdominal pain, particularly in the lower right quadrant, nausea, vomiting, and fever. Therefore, it is important to consider it as a differential diagnosis when evaluating a patient with suspected acute appendicitis.

Incorrect Options Explanation:

“Surgery is only indicated if rupture is suspected” – This is incorrect. Surgery, specifically an appendectomy, is the standard treatment for acute appendicitis, regardless of whether rupture is suspected or not.
“The risk of developing the disease increases with age” – This is incorrect. Acute appendicitis can occur at any age, but it is most common in people between the ages of 10 and 30.
“There is no role for antibiotics” – This is incorrect. Antibiotics are often used in conjunction with surgery to treat acute appendicitis and prevent complications such as peritonitis.
“It usually presents with rectal bleeding” – This is incorrect. Rectal bleeding is not a typical symptom of acute appendicitis. The most common symptom is abdominal pain.

Overview of Acute Appendicitis:

Acute appendicitis is an inflammation of the appendix, a small, finger-shaped pouch that projects from the colon on the lower right side of the abdomen.
The condition is considered a medical emergency and typically requires surgical removal of the appendix.
The most common symptom of acute appendicitis is abdominal pain, which usually begins near the belly button and then moves to the lower right side of the abdomen. Other symptoms may include loss of appetite, nausea, vomiting, constipation or diarrhea, inability to pass gas, and a low-grade fever.
Acute appendicitis is most commonly diagnosed through a physical examination, blood tests, urine tests, and imaging tests such as an abdominal ultrasound or CT scan.
If left untreated, acute appendicitis can lead to serious complications, such as a ruptured appendix that can cause a potentially life-threatening infection of the abdomen (peritonitis).

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