Acute appendicitis

• Bacterial invade the appendix wall after there has been some kind of intestinal obstruction

Signs;

• Tachycardia
• Fever
• Furred tongue
• Lying still
• Foetor/flushing
• Coughing hurts
• Shallow breaths
• Guarding
• Rebound and percussion tenderness
• PR painful on the right

Special tests

• Rovsing’s sign – pain more in the RIF when the LIF is presed
• In women do a PV – does she have salpingitis
• Risk of appendicitis can be scored using Alvarado score, based on;
  • Migration of pain
  • Nausea/vomiting
  • Anorexia
  • RIF tenderness
  • Rebound pain
  • Raised temp
  • Raised WCC
  • Neutrophil count >75%
• This scoring system has poor sensitivity

Treatment

• Prompt appendicectomy with antibiotic cover to prevent wound infections (e.g. metronidaxole, cefuroxime)

Complications

• Perforation
• Appendix mass – may result when the inflamed appendix becomes covered in omentum
• Appendix abscess – treatment involves drainage

Appendicitis in pregnancy

• Occur in 1 in 1000 pregnancies
• Associated with higher mortality – especially from 20 weeks gestation
• Perforation is commoner
• Associated with fetal mortality
• As pregnancy progresses the appendix migrates so the pain is often less well localised and the signs of peritonism less obvious