Appendicitis Flashcards
Commonest emergency operation
Appendicitis
What is at the base of appendix
Convergence of the teniae coli
Blood supply to appendix
Appendicular artery, arises from ileocolic artery, part of superior mesenteric artery
Cause of appendicitis
Idiopathic, obstruction due to foacalith, bacterial, viral, parasites
Classic picture of appendicitis
Umbilical pain that migrates to right iliac fossa, nausea, vomiting, +/- constipation, vague localised pain that can’t be pinpointed early on, anorexia
What is the rosvings sign in appendicitis
Pressing on the left causes pain on right
Psoas sign in appendicitis
Patient keeps right hip flexed as this lifts inflamed appendix off psoas muscle
Obturator sign in appendicitis
If appendix is touching the obturator internus then flexing the hip and internally rotating causes pain
Pointing sign in appendicitis
Being able to pin-point a location indicates the appendix is touching the body wall and has progressively worsened in inflammation
Patient presents with constant vomiting and diarrhoea with pain around umbilicus. There’s no shifting of pain
Postileal appendicitis, rare
Patient presents with pain in right iliac fossa with diarrhoea and frequent micturition
Pelvic appendicitis
What type of appendicitis presents with very few signs
Retrocaecal appendicitis
Differential diagnosis of appendicitis
Gastroenteritis Mesenteric lymphadenitis Meckel's diverticulum Intussusception Henoch-Schonlein Purpura Lobar pneumonia
Investigations for appendicitis
Mostly a clinical diagnosis
Ultrasound is useful in women and kids
Abdominal x-ray to rule out differentials
Bloods and urinalysis
Important blood markers in appendicitis
CRP, WCC
