Appendicitis Lecture Notes

Introduction

• Presenter: Tom from Zero to Finals
• Topic: Appendicitis
• Resources: Written notes at zerodefinals.com and the Zero to Finals Surgery book

Overview of Appendicitis

• Definition: Inflammation of the appendix.
• Peak Incidence: Ages 10-20 years, less common in young children and adults over 50.

Pathophysiology

• Appendix Structure: Small tube from the cecum, part of the large bowel.
  • Located where three tinier coli meet.
  • Single opening connects to the bowel, leading to a dead-end.
• Infection Process:
  • Obstruction leads to pathogen trapping, causing infection and inflammation.
  • Inflammation may lead to gangrene and rupture.
  • Rupture releases fecal and infective material into the peritoneal cavity, causing peritonitis.

Signs and Symptoms

• Key Symptoms:
  • Abdominal pain: Starts centrally, moves to right iliac fossa (RIF) within 24 hours.
  • Tenderness at McBurney's point.
  • Anorexia, nausea, vomiting, low-grade fever.
• Classical Signs:
  • Rovsing's sign: Pain in RIF when palpating left iliac fossa.
  • Guarding, rebound tenderness, and percussion tenderness in RIF.
  • Indications of peritonitis from rupture.

Diagnosis

• Clinical Presentation: Key for diagnosis with raised inflammatory markers.
• Imaging:
  • CT scan for confirmation, especially if another diagnosis is likely.
  • Ultrasound for females and children to avoid radiation.
• Observation: Period of observation if diagnosis is unclear.
• Diagnostic Laparoscopy: When clinical suspicion is high but tests are negative.

Differential Diagnoses

• Ectopic Pregnancy: Consider in females of childbearing age; confirm with HCG test.
• Ovarian Cysts: Investigated with pelvic ultrasound.
• Meckel's Diverticulum: Malformation of distal ileum, usually asymptomatic.
• Mesenteric Adenitis: Inflamed abdominal lymph nodes, associated with upper respiratory infections.

Management

• Emergency Admission: Needed for suspected cases.
• Definitive Treatment: Appendicectomy (surgical removal).
  • Laparoscopic surgery preferred due to fewer risks and faster recovery.
• Complications:
  • Bleeding, infection, pain, scars.
  • Damage to surrounding organs, normal appendix removal.
  • Anaesthetic risks, venous thromboembolism.

Additional Tips

• Pediatric Consideration: Older children managed by adult surgical teams in local hospitals.
• Clinical Tips:
  • Assume pregnant in childbearing females until proven otherwise.
  • Use serum HCG test when diagnosing abdominal pain in females.

Conclusion

• Resource Promotion: Zero to Finals Patreon account for early access and additional resources.
• Thank You Note: Acknowledge viewer support and encourage further learning.