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Surgery Acute Appendicitis Exam Questions and Answers
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Surgery Acute Appendicitis Exam Questions and Answers
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Surgery Acute Appendicitis ExamQuestions and Answers
What is the most common cause of an acute abdomen in the UK? - Answer-After non-
specific abdominal pain it is appendicitis.
NB: 10% of the population will develop acute appendicitis (most commonly between 10-
20 - but can happen at any age)
How does an acute appendicitis present? - Answer-1) Initially colicky peri-umbilical pain
-> moves to RIF (McBurney's point - 2/3rd umbilicus to ASIS) as peritoneum becomes
involved. Often aggravated by coughing, deep breathing & movement.
2) N&V, anorexia, change of bowel habits
3) Low-grade pyrexia may develop
4) Tachycardia may be sign of peritonitis
5) Localised tenderness, guarding, rebound tenderness/percussion tenderness in RIF
6) Rovsing's sign may be positive (palpation of LLQ increases pain felt in RLQ - irritates
the peritoneal lining)
7) Psoas sign (extension of R hip w/ pt on L side) in retrocoecal appendicitis
8) Obturator test (flex + internally rotate R hip) - also called Cope sign - positive if
appendix in close relation to obturator internus.
9) Localised tenderness on DRE may be only sign of retrocaecal or pelvic appendicitis.
10) Just after perforation, child may sit up in bed apparently better but tachycardic. Then
other signs of peritonitis develop.
NB: elderly may present without pain, but may have confusion and shock. deterioration
is rapid!
Why does the pain move from peri-umbilical location to RIF in appendicitis? - Answer-
Internal organs + visceral peritoneum have no somatic innervation.
Initial inflammation limited to the appendix wall is felt as referred pain to the peri-
umbilical region and is caused by activation of visceral c-fibres in the mid gut.
As the inflammation progresses and irritates the parietal peritoneum, somatic pain is felt
at McBurney's point (2/3 from umbilicus to ASIS) i.e. RIF.
What happens in the appendix wall during acute appendicitis? - Answer-Gut organisms
invade the appendix wall after lumen obstruction by lymphoid hyperplasia, faecolith or
filarial worms. This leads to oedema, ischaemic necrosis and perforation.
What may you see on blood test in acute appendicitis? - Answer-1) Neutrophil
leucocytosis
2) Elevated CRP
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