Appendicitis

Happy Monday, and welcome to Medical Mondays! This week’s topic is…Appendicitis!

Simply put, appendicitis is the inflammation of the appendix. It’s a tiny little organ (actual usefulness is debatable), but that wormy-looking sucker can cause a wholeee lot of pain and misery!

Causes

• Lymphoid tissue hyperplasia (most common, especially in younger patients)
• Fecaliths (more common in elderly patients)
• Foreign bodies
• Infection (e.g. parasites)
• Neoplasia (e.g. adenocarcinoma, carcinoid tumor)

Presentation/Signs & Symptoms

• Classically presents as periumbilical pain that shifts toward the right lower quadrant (RLQ) followed by:
  • Nausea
  • Vomiting
  • Anorexia
• McBurney’s Point (pain in the distance from the umbilicus to the right anterior superior iliac spine [ASIS])
• Psoas Sign (RLQ pain with right hip flexion or extension)
• Obturator Sign (RLQ pain with right thigh flexion + internal rotation while in supine position)
• Rovsing Sign (referred pain to RLQ when palpating lower left quadrant [LLQ])

For the record, not all of these signs + symptoms will/can be seen, but they can help to narrow down the differential diagnosis!

Diagnosis

This is based on a thorough clinical assessment, with imaging studies and lab findings to support the diagnosis.

Ultrasound tends to be the screening test of choice for patients, and is safe to do on pregnant women + children.

• “Target” appearance
• Dilated lumen
• Periappendiceal fluid collection

CT scan is the diagnostic test of choice in patients with suspected appendicitis because it’s the most sensitive + specific.

• Thickened enhancing walls
• Periappendiceal inflammation with fat stranding
• Dilated appendiceal lumen (> 6mm diameter)

Patients may also have mild-to-moderate leukocytosis with a left shift (white blood cell [WBC] count > 10,000)!

Treatment

The definitive treatment is appendectomy. It’s the most common disease in kids that requires emergency surgery!

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Disclaimer: This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)