- Accounts for 2-10% surgical admissions
- Almost twice as common in men
- Any age affected, commonest in 20s & 30s
- You can have it more than once - getting it does not always mean an operation or admission to hospital is required
- A normal appendix is removed in 1:5 cases
There are no diagnostic tests, scoring systems or algorithms that give a conclusive diagnosis – Appendicitis is a clinical diagnosis based on experience.
- As for diagnosing the type of inguinal hernia - you will be wrong 50% of the time
- In general, 50% of the RIF pain you see in A&E goes home, 25% have mesenteric adenitis and the rest genuine appendicitis.
- Please remember to do an Amylase!
- Please remember to do a pregnancy test in ALL women who are in their childbearing years.
- Don’t waste money on CRP, or ESR, but do dipstick the urine!
- Don’t start antibiotics before surgery, unless the patient is septic and you have done blood cultures first.
- Classically - central colicky abdominal pain moving becoming sharp right iliac fossa pain
- Nausea, vomiting, anorexia, foetor oris
- Pyrexia - degree depends on level of sepsis
- Rovsing's sign = pain in right iliac fossa on palpation of the left iliac fossa - NOT diagnostic or always present
- Are for narrowing the differential (below), not for making the diagnosis
- Pregnacy test - see above
- Amylase - see above
- Plain AXR - waste of time
- USS - useful in experienced hands, but only if the appendix can be visualised
- CT - only really indicated if a mass is palpable (but do USS first in younger patients)
- Mesenteric Adenitis
- Non-specific abdominal pain (NSAP)
- Pelvic inflammatory disease (PID)
- Renal colic
- Ectopic pregnancy
- Constipation (this is not a diagnosis, but a symptom)
- Crohn's disease
- Caecal carcinoma
- Mucocele of the gallbladder
- Psoas abscess
- Pelvic kidney
- Ovarian cyst
- Adequate analgesia
- Antibiotics only with evidence of sepsis
- Period of active observation if there is clinical doubt (esp in children) - this means free fluids can be taken
- Never be afraid to ask for a second opinion (esp in children)
- Diagnostic laparoscopy is very useful esp in women. If a 'firm' clinical diagnosis is made in men, there is little benefit in laparoscopy except in overweight patients.
- 5mm laparoscope in children is useful
- Try to avoid muscle cutting incisions - they are painful