Appendicitis



Inflammation of the appendix:

Presumed obstruction of the appendix lumen:


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


Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 13/12/21.