Appendicitis - Edubirdie

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

327

Pages:

5
Author:

Mariam A. A.

Appendicitis Definition Inflammation of the appendix Epidemiology Most commonly in the second decade of life More common in males Key Info Should be considered in any patient presenting with acute abdominal pain Previous appendicectomy dose do not rule out appendicitis Rare cases Stump appendicitis Inflammation in the remaining small piece/stump Usually a clinical diagnosis Risk Factors Age Being a male Family history Low fibre diet Cystic fibrosis Pregnant in second trimester Protective Factors High fibre diet Hydration Regular exercise Clinical Features History Physical Exam Findings Right iliac fossa tenderness Right lower quadrant peritonism Nausea and vomit Revising sign: Low grade fever Palpation of LIF -> RIF pain Pain begins as poorly localised central abdominal visceral pain Psoas sign: Umbilical pain Extension of right thigh in left lateral position -> RIF pain Right iliac fossa pain Obturator sign: Guarding Internal rotation of the flexed right thigh -> pain Urinary symptoms Hop test: Diarrhoea Hopping or jumping -> abdominal pain Rigid and tender abdomen Rebound tenderness Murphy’s triad Nausea and vomit Low grade fever RIF pain Investigations If confirmed clinically -> no need for investigations except for potential comorbidity, anaemia or dehydration. Ultrasound First line: Non-compressible appendix -> >6mm in diameter Appendicolith Wall thickening -> three or more cm Secondary sonographic signs: Free fluid within RIF Echogenicity in mesenteric fat -> rules out other DDx such as mesenteric adenitis Target sign CT with contrast Less favourable in paediatrics Most accurate imaging modality for confirming diagnosis in adults Findings: D ilated (over 6mm), thick-walled appendix with enhanced walls Fat stranding Appendicolith Abscess MRI More favourable in paediatrics Management Initial management Nill per orally IV fluids Analgesia IV antibiotics Appendicostomy + antibiotic therapy Mainstream treatment Abscess drainage if there is one IV gentamicin + amoxicillin Complications Perforation -> peritonitis Most common Sepsis Septic shock Abscess Bowel obstruction Necrotising fasciitis