Appendicitis

March 2018 | by EMauthor

Appendicitis is one of the commonest surgical presentations to the ED. Appendicitis results from obstruction of the lumen of the appendix, due to a faecolith, lymphoid tissue, or adhesions. This increases intra-luminal pressure and the appendix perforate causing general peritonitis.

Clinical features of appendicitis

•Abdominal pain: initially central and poor resulting in a well-localized, sharp pain in the right iliac fossa.

•Rovsing’s sign: palpation in the left iliac fossa causes pain in the right iliac fossa.

•Other symptoms: nausea, vomiting, anorexia, constipation, fever.

Investigations for appendicitis

Do not order abdominal films in conditions such as appendicitis. Remember that a chest radiograph is equivalent to 4 days of background radiation but an abdominal film is equivalent to 4 months of radiation see here.

•Diagnosis is clinical.

•Urine should be checked to exclude pregnancy or a UTI as the cause of pain. However, 30–40 % of patients will have an abnormal urinalysis in appendicitis.

•White cell count and CRP may be elevated, but can be normal.

•Ultrasound scan can be useful and may also identify other pathologies as the cause of pain, e.g. ectopic pregnancy, ovarian torsion.

ED management of appendicitis

•Fluid resuscitation — as required by the patient’s haemodynamic status.

•Analgesia (there is no evidence that opiates mask signs of peritonism).

•Nil by mouth.

•Surgical referral.

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