Appendicitis Overview

Introduction

• Presenter: Tom from zero2finals.com
• Resources: Zero to Finals website and surgery book

Definition

• Appendicitis: Inflammation of the appendix
• Peak incidence: Patients aged 10-20 years
• Less common in young children and adults over 50

Pathophysiology

• Appendix is a small tube from the cecum of the large bowel
• Located at the junction of three tinier coli, longitudinal muscles of the large intestine
• Pathogens can get trapped due to obstruction, leading to infection and inflammation
• Possible progression to gangrene and rupture
• Rupture results in peritonitis (inflammation of the peritoneal lining)

Signs and Symptoms

• Abdominal Pain: Starts centrally, migrates to right iliac fossa (RIF)
• McBurney's Point: Tender area from anterior superior iliac spine to umbilicus
• Other Symptoms:
  • Anorexia
  • Nausea and vomiting
  • Low-grade fever
  • Rovsing's sign (pain in RIF when palpating left iliac fossa)
  • Guarding, rebound tenderness, and percussion tenderness suggesting peritonitis

Diagnosis

• Based on clinical presentation and raised inflammatory markers
• CT Scan: Helpful in confirming diagnosis
• Ultrasound: Useful in females (to rule out gynecological issues) and children
• Diagnostic Laparoscopy: For unclear cases, may proceed to appendectomy

Differential Diagnoses

• Ectopic Pregnancy: Use HCG tests to exclude pregnancy in females
• Ovarian Cysts: Cause pain, diagnosed with pelvic ultrasound
• Meckel's Diverticulum: Malformation of distal ileum, can cause complications
• Mesenteric Adenitis: Inflamed abdominal lymph nodes, common in children

Management

• Emergency admission for suspected cases
• Appendicectomy: Definitive treatment; laparoscopic preferred
• Complications: Include bleeding, infection, organ damage, and thromboembolism

Special Considerations

• Older children often managed by adult general surgical teams
• Pediatric departments can be helpful for managing pain relief and IV fluids

Additional Resources

• Zero to Finals Patreon for early access to videos and educational materials

Conclusion

• Important to consider differential diagnoses and manage appropriately
• Always verify pregnancy in women of childbearing age before proceeding with diagnostics involving radiation