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Appendicitis

Definition
  • An inflammation of the appendix, a small pouch attached to the beginning of the large intestine.
Aetiology/Causes
  • Most commonly due to obstruction of the appendix lumen by faecoliths (hardened stool).

What are some other causes of appendicitis (excluding faecoliths)

  • Lymphoid hyperplasia
  • Foreign bodies
  • Tumours.
Clinical Presentation
  • Initial peri-umbilical abdominal pain that later localises to the right iliac fossa.
  • Associated symptoms: nausea, vomiting, loss of appetite, and fever.
  • Examine for
    • Peritonitis if perforation
    • Guarding and rigidity, rebound tenderness
    • McBurney’s point tenderness ā€“ 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

What percentage of patients have classical symptoms of peri-umbilical pain localising to right iliac fossa, nausea and loss of appetite

  • 50%
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
  • Surgical removal (appendicectomy) ā€“ 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
Differential Diagnoses
  • Gastroenteritis, ectopic pregnancy (in females), Meckel’s diverticulitis, urinary tract infections, nephrolithiasis, and more.

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