Acute appendicitis

Medical Emergency - Acute Appendicitis is a medical emergency and there are no diagnostic tests for it! If the history is indicative of appendicits, don't bother with tests.

Definition

Acute appendicitis is acute inflammation of the appendix

Epidemiology

10% of the population will develop acute appendicitis. If untreated, the sequelae have a high mortality rate.

Pathophysiology

No specific cause of this disease has been identified. It can lead to peritonitis and shock if left untreated.

The main cause of the classic symptoms is generalised umbilical pain, as the appendix irritates the gut, which has poorly localising of visceral pain receptors. As the appendix gets more inflamed, it irritates the somatic nerves of the parietal peritoneum, causing localised right iliac fossa pain.

Risk Factors

Rare <5yrs but has a high rate of perforation (90%) in this group. Highest between 10-20 years of age but can occur younger than that.

Clinical Features

The classical presentation is a generalised abdominal pain, after a few hours localising to the right iliac fossa, and becoming more severe.

However, younger children and elderly people are bad at localising pain so the classical right lower quadrant pain may not be elicited with a general abdominal pain being complained of instead. If the child can hop, appears well and sit forward unsupported, appendicitis is unlikely to be the cause.

Other features include:

• Fever
• Pulse↑
• Vomiting
• Abdominal tenderness

In older children (i.e. the ones that you can practically treat as adults)

• Rebounding
  • Put pressure on the abdomen to elicit tenderness and withdraw quickly. In rebounding, this results in more pain as the pressure is withdrawn

Investigations

Medical Emergency - Acute Appendicitis is a medical emergency and there are no diagnostic tests for it! In a young person, if the history is indicative of appendictis, you don't bother with scans.

However, if in doubt:

• FBC - 95% of appendicitis patients will have an elevated white cell count.
• Dipstick urine to rule out UTI
• Pregnancy test to rule out ectopic pregnancy

Management

Appendicetomy - it has the highest success rate of any surgical procedure as it has relatively few risks, in the unperforated, and prevents near-certain death.

Prognosis

Good. Usually, no negative after-effects of the operation.