Appendicitis

Appendicitis is an inflammation of the appendix, often presenting with right lower abdominal pain, nausea, vomiting, and decreased appetite.

Signs and Symptoms

Patients typically experience acute abdominal pain that migrates to the right lower quadrant, known as McBurney's point. Other symptoms include nausea, vomiting, and fever. In children under three years, the classic migration of pain may not appear. Pain can also localise differently if the appendix is retrocecal or lies within the pelvis.

Causes

Appendicitis typically results from a blockage of the appendix lumen, often caused by a faecolith. This blockage leads to increased pressure, reduced blood flow, and bacterial growth, causing inflammation and tissue death. If untreated, the appendix may rupture, leading to peritonitis and sepsis.

Diagnosis

Diagnosis involves a thorough history, physical examination, and imaging tests. Signs of appendicitis include migratory right iliac fossa pain, rebound tenderness, and fever. Laboratory tests such as complete blood count (CBC) and C-reactive protein (CRP) are also helpful. Imaging techniques like ultrasound and CT scans are commonly used, with CT scans being more accurate but ultrasounds preferred for children and pregnant women due to radiation concerns.

Imaging

Ultrasound

Ultrasound is particularly useful for children and can show the inflamed appendix and surrounding fluid.

Computed Tomography

CT scans offer high sensitivity and specificity for diagnosing appendicitis in adults and adolescents.

Magnetic Resonance Imaging

MRI is increasingly used for pregnant women and children to avoid radiation exposure. It is particularly useful in the second and third trimesters of pregnancy.

Treatment

The primary treatment for appendicitis is surgical removal of the appendix, known as an appendectomy. This can be performed through open surgery or laparoscopically. Laparoscopic appendectomy is preferred due to shorter recovery times and less postoperative pain. Antibiotics may be used in certain cases of non-ruptured appendicitis, but surgery is still the standard treatment to prevent complications.

Surgery

Open Appendectomy

Open appendectomy involves a single large incision to remove the appendix and is performed under general anaesthesia. This method may involve abdominal drainage if the appendix has ruptured.

Laparoscopic Appendectomy

Introduced in 1983, this minimally invasive technique uses small incisions and specialised instruments to remove the appendix, offering advantages such as shorter recovery times and reduced postoperative pain.

Post-Surgery

Recovery from appendectomy usually involves a few hours to days in the hospital, with a full recovery taking between two to six weeks, depending on whether the appendix had ruptured.

Prognosis

Most patients recover quickly after surgery, but complications can occur if treatment is delayed. The recovery period typically ranges from 10 to 28 days, though it may extend to three weeks for young children.

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Self-assessment MCQs (single best answer)

Which of the following is the most common initial symptom of appendicitis?

What is McBurney's point?

Which imaging technique is preferred for diagnosing appendicitis in children and pregnant women?

What is the typical cause of appendicitis?

Which of the following is NOT a common symptom of appendicitis?

What is the gold standard treatment for appendicitis?

Which surgical technique for appendectomy is associated with shorter recovery times and less postoperative pain?

What is a common complication if appendicitis is left untreated?

For which patient population is MRI particularly useful in diagnosing appendicitis?

How long does full recovery usually take after an appendectomy, depending on whether the appendix had ruptured?