Inflammation of the appendix:
- Max in teenagers / young adults or elderly
- Symptoms usually <24hrs in young, may be longer onset in elderly
Presumed obstruction of the appendix lumen:
- Lymphoid hyperplasia (generalised "adenitis" or local)
- Faecolith
- Parasites (v. rare)
- FB or neoplasia (elderly - beware occult caecal neoplasm with atypical presentation)
Clinical
History
- Anorexia and periumbilical ache (T10) then
- Periumbilical pain then
- RIF pain (peritoneal) and vomiting ±fever
Signs
- Local RIF peritonism - at Mc Burney's point
- Rovsing's sign - palp. LIF = pain in RIF
- Psoas sign - RIF pain with active Rt hip flexion OR passive extension
- Obturator sign - pain on internal rotation flexed hip
- Dunphy's sign - local RIF pain with coughing
Differential Dx
Woman:
Ectopic pregnancy (check βHCG), Mittelschmerz, PID, #ovarian cyst
Men:
Testicular torsion, renal colic
Elderly (beware):
AAA, diverticulitis, mesenteric ischaemia
Children:
Mesenteric Adenitis, gastroenteritis, intussusception, HSP, UTI (MSU in all), Meckel's diverticulitis, Pneumonia
Investigations
- N.B. Pregnancy test
- FBC -
- Urinalysis -
- CRP -
- US not particularly useful (negative US = Neg LR 0.2) but if appendix diameter >6mm = appendicitis