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.
