Appendicitis

What is appendicitis?

Inflammation of the vermiform appendix due to obstruction, bacterial overgrowth, and subsequent infection.

What is the pathophysiology of appendicitis?

Obstruction → increased intraluminal pressure → impaired blood flow → bacterial proliferation → inflammation → possible perforation.

What organisms commonly cause appendicitis infection?

• E. coli

• Bacteroides

• Pseudomonas

• Streptococcus species

What are risk factors for appendicitis?

• Adolescence

• Male sex

• Family history

• GI infections

What are symptoms of appendicitis?

• Periumbilical pain migrating to RLQ

• Anorexia

• Nausea/vomiting

• Fever

What symptom progression is classic for appendicitis?

Periumbilical visceral pain → localized RLQ somatic pain.

What symptoms suggest perforation?

• Sudden relief then worsening pain

• High fever

• Diffuse abdominal pain

• Signs of sepsis

What physical exam findings occur in appendicitis?

• McBurney point tenderness

• Rebound tenderness

• Guarding

• Rovsing sign

• Psoas sign

• Obturator sign

What exam findings suggest perforation?

• Diffuse tenderness

• Rigidity

• Peritoneal signs

• Tachycardia

• Hypotension

What labs support appendicitis diagnosis?

• Leukocytosis

• Elevated CRP

• Mild electrolyte abnormalities from vomiting

What lab finding is most common in appendicitis?

Leukocytosis.

What labs suggest perforation?

• High WBC

• Elevated lactate

• Metabolic acidosis

What imaging is preferred for appendicitis?

CT abdomen/pelvis with contrast.

What CT findings support appendicitis?

• Enlarged appendix >6 mm

• Wall thickening

• Periappendiceal fat stranding

• Appendicolith

What ultrasound findings support appendicitis?

• Noncompressible tubular structure

• Diameter >6 mm

• Increased echogenic fat

What imaging finding suggests perforation?

Periappendiceal abscess or free air.

What are diagnostic criteria for appendicitis?

Clinical presentation + RLQ tenderness + supportive labs + imaging showing inflamed appendix.

What scoring system helps assess appendicitis probability?

Alvarado score.

What are treatment goals for appendicitis?

• Control infection

• Prevent perforation

• Remove inflamed appendix

• Stabilize patient

What is first-line treatment for uncomplicated appendicitis?

Appendectomy.

What antibiotics are used preoperatively?

• Piperacillin-tazobactam

• Ceftriaxone + metronidazole

• Cefoxitin

What is the treatment for perforated appendicitis?

• Broad-spectrum antibiotics

• Surgical source control

• Drain abscess if present

What non-pharmacologic treatments are used?

• IV fluids

• NPO status

• Pain control

• Surgical consultation

What is the role of surgery in appendicitis?

Definitive treatment to prevent perforation and complications.

What complications can occur from appendicitis?

• Perforation

• Abscess

• Peritonitis

• Sepsis

• Ileus

What complication is most common if diagnosis is delayed?

Perforation.

What monitoring is required in appendicitis?

• Vitals

• Pain progression

• WBC trends

• Signs of perforation

• Postoperative recovery

What follow-up is needed after appendectomy?

Wound care, infection monitoring, gradual return to activity.

What prevention strategies reduce appendicitis risk?

No proven prevention

What conditions can mimic appendicitis?

• Gastroenteritis

• Mesenteric adenitis

• Ovarian torsion

• Ectopic pregnancy

• Kidney stone

• Crohn disease

What feature helps differentiate ovarian torsion from appendicitis?

Sudden severe pelvic pain with adnexal tenderness on exam.

What commonly causes appendiceal obstruction?

• Lymphoid hyperplasia

• Fecalith

• Foreign bod

• Tumor