Appendicitis
- inflammation of the vermiform appendix
- example of acute inflammation but may turn chronic
- arises from blockage of appendix
- faecoliths
- food residues
- lymphoid hyperplasia
- diverticulosis of appendix
- carcinoid tumour
- or specific infection
- Yersinia
- Pseudomonas
- Typhoid
- Tuberculosis
- Actinomycetes
- or Inflammatory Bowel Disease
Symptoms and signs
- Central abdominal pain, cramping or colicky
- Nausea
- Vomiting uncommon
- ?Loose stool
- After ~8 hours pain localises to RIF & becomes sharp/stabbing
- made worse by coughing/moving
- Pyrexia
- Flushed
- Fetor
- White furred tongue
- tachycardia
- tender with guarding in McBurneys' point
- PR tender anteriorly if peritonitis developing
- Inflamed appendix stuck to bladder may cause frequency and pyuria
Investigations
- FBC
- WCC - >10x10^9 (but may not necessarily be raised)
- USS
- mass or abscess not useful in early appendicitis
- MSU
- b-HCG
- to exclude ectopic pregnancy
Differential Diagnosis
Classical presentation
Non-classical
- abdominal
- urinary tract
- gynaecological
- extra-abdominal
- referred pain from nerve roots
- degenerative and malignant disease affecting T11,T12
- Referred pain from right lower lobe pneumonia
- referred from right testicular
torsion
Treatment
- NBM
- appendicectomy
- prophylactic metronidazole 1g PR 1 hour before
- fluids
- analgesia
- AXR
- DVT prophylaxis
- Post-operatively
- uncomplicated gets two doses antibiotics
- perforated keep on antibiotics for 5 days
Complications
- Perforation leading to generalised peritonitis
- Appendix mass
- Appendix abscess
- pelvic abscess
- sub-phrenic abscess
- paralytic ilieus
- septicaemia
- portal pyaemia
- tubal adhesions - leading to infertility
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