Acute Appendicitis Overview

Questions and Answers

What is the Rovsing's sign indicative of?

Low-grade pyrexia and abdominal swelling

Pain relief when lying with the right hip flexed

Pain in the right iliac fossa when palpating the left iliac fossa (correct)

Pain in the hypogastrium upon hip flexion and internal rotation

What is the primary method for diagnosing acute appendicitis?

Laboratory blood tests

Patient's medical history alone

Radiological imaging techniques

Clinical assessment and scoring systems (correct)

Which score is most predictive of acute appendicitis when it is 7 or greater?

Glasgow Coma Scale

Alvarado score (correct)

Bristol Stool Chart

Westergren score

What is the primary surgical treatment for acute appendicitis?

Appendectomy Signup and view all the answers

Which of the following treatment approaches is used for initially managing acute appendicitis conservatively?

Bowel rest and intravenous antibiotics Signup and view all the answers

What is the most common cause of an acute abdomen in young adults?

Acute appendicitis Signup and view all the answers

What is the typical position of the base of the appendix?

At the confluence of the three taeniae coli of the caecum Signup and view all the answers

Which condition is most often associated with the obstruction of the appendix lumen?

Strictures or faecoliths Signup and view all the answers

What initial symptom is often associated with acute appendicitis?

Poorly localized colicky abdominal pain Signup and view all the answers

How does the pain from acute appendicitis usually progress as the condition worsens?

It migrates to the right iliac fossa and becomes more intense Signup and view all the answers

Which of the following symptoms is considered a constant feature in appendicitis?

Anorexia Signup and view all the answers

What type of pain do patients commonly experience once the parietal peritoneum becomes irritated in appendicitis?

More intense and localized somatic pain Signup and view all the answers

What is a common gastrointestinal symptom that follows the onset of abdominal pain in appendicitis?

One or two episodes of vomiting Signup and view all the answers

Study Notes

Acute Appendicitis Overview

Acute appendicitis is the leading cause of acute abdomen in young adults and is the most common urgent abdominal surgery performed.

Anatomy of the Appendix

The appendix is a blind muscular tube with four layers: mucosal, submucosal, muscular, and serosal.
It is the undeveloped distal end of the large caecum, initially short and broad at birth.
Growth of the caecum during childhood commonly rotates the appendix into a retrocaecal position; in about 25% of cases, it remains in a pelvic, subcaecal, or paracaecal position.
The base of the appendix consistently located at the junction of the three taeniae coli of the caecum, helpful during surgery.
Average length of the appendix ranges from 7.5 to 10 cm.

Etiology of Appendicitis

Luminal obstruction of the appendix is a primary cause; faecoliths or strictures are frequently involved.
Obstruction leads to increased mucus secretion and inflammatory response, raising intraluminal pressure and obstructing lymphatic drainage.
Resulting edema and mucosal ulceration facilitate bacterial movement to the submucosa.

Clinical Features

Initial symptoms include vague, colicky abdominal pain, often starting in the periumbilical region, resembling small bowel obstruction pain.
Accompanied by anorexia, nausea, and typically one or two vomiting episodes following pain onset.
Anorexia is a consistent clinical indicator.
As inflammation progresses, pain localizes to the right iliac fossa, leading to more intense somatic pain.
Signs include low-grade fever, localized tenderness, muscle guarding, rebound tenderness, and specific signs such as:
- Rovsing's Sign: Pain in the right iliac fossa triggered by palpation of the left iliac fossa.
- Psoas Sign: Pain relief in the right hip when flexed indicates an inflamed appendix adjacent to the psoas muscle.
- Obturator Sign: Pain in the hypogastrium upon internal rotation and flexion of the hip suggests contact with the obturator internus.

Investigations

Diagnosis primarily clinical, with concern for false positives leading to unnecessary appendectomy (15-30% rate).
Clinical scoring systems assist, with the Alvarado Score being widely utilized; a score of 7 or above strongly indicates acute appendicitis.

Treatment

Medical Management: Involves bowel rest and IV antibiotics, commonly metronidazole alongside 3rd generation cephalosporins; ertapenem is increasingly used for broad coverage in single daily doses.
- Approximately 25% of conservatively treated patients might require surgery within a year due to recurrent appendicitis, often with uncomplicated outcomes.
Surgical Management: The definitive treatment is appendectomy, which can be performed via open or laparoscopic techniques.

Description

Explore the essentials of acute appendicitis, one of the leading causes of acute abdomen in young adults. This quiz covers the anatomy of the appendix and the rationale behind appendectomy as a common surgical procedure.