(Surgery)

Overview

• Acute inflammation of the vermiform appendix → mainly due to obstruction of the lumen of the appendix (by faecolith, infective agents or lymphoid hyperplasia)
• Most common surgical emergency of the abdomen
• 10-19 years old, M>F

Making Diagnosis

Clinical Features:

• Migrating abdominal pain → starts central (peri-umbilical) then moves to RLQ (can be worse on movement and coughing)
• Non-Specific Symptoms → N&V, Anorexia (almost always present → if patient hungry then appendicitis less likely), vomiting, mild fever, diarrhoea, constipation
• RLQ Tenderness (McBurney point tenderness) → point that lies one-third of the distance laterally on a line drawn from the umbilicus to the right ASIS
• Rovsing’s Sign → RLQ pain when LLQ is deeply palpated
• Psoas Sign → pain on extending hip if retrocaecal appendix
  • Can also be sign of psoas abscess (CT abdomen should be done)
• Obturator Sign → pain on internal rotation of flexed thigh
• Blumberg Sign → Rebound Tenderness in RLQ

Investigations: