Page 2 of 2: Surgery / MCQ/ Regarding appendicitis

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Acute appendicitis is one of the most common causes of an acute abdomen in the Western world. In 90% of cases the infection develops as a result of obstruction of the appendix, for example, by a faecolith or an engorged lymphoid system, for example by a viral infection.

It is the most common surgical emergency of childhood, with three or four children per 1000 having their appendix removed every year.

This condition can occur at any age but in children it is most often seen over five years of age.

contd.......

NEHRA · Credits: 12123 My Scrapbook

Possible signs include:

* lying still, with shallow breaths and reluctant to cough
* tachycardia
* fever 37.5-38.5øC, worsening with perforation
* foetor oris - halitosis
* furred tongue
* flushed
* right iliac fossa signs:
o tenderness:
+ dependent on position of viscus; localised tenderness per se is a more valuable sign than tenderness localised over McBurney's point
+ not evident before later inflammation of serosa and parietal peritoneum
+ often masked in obese due to inability to displace viscus
o rigidity:
o after the development of localised tenderness
+ localised initially progressing to generalised with perforation or increasing peritonitis
o guarding
* rebound tenderness
o tender on the right per rectum
* a mass in the right iliac fossa is suggestive of abscess formation
* positive Rovsing's sign
* with retrocaecal appendicitis, possible positive:
o psoas sign
o obturator sign
* paraesthesia:
o occasionally reported in the distribution of T10-T12 on the right side
o test with light scratch with a sterile needle

I AM REPEATING THIS LINE:--

TENDERNESS is often masked in obese due to inability to displace viscus

NEHRA · Credits: 12123 My Scrapbook

The clinical features of acute appendicitis in the elderly are masked by:

* laxity of the abdominal musculature and hence late or non-development of rigidity
* typically slower presentation of other classical symptoms
* delayed presentation because pain is ascribed by patient to constipation and laxatives are taken instead
* similarity of presentation to intestinal obstruction, which is more common in this age group; enemas prescribed for obstruction may enhance peritonitis

Consequently, elderly patients with acute appendicitis tend to present later in the course of the illness and have a worse prognosis.
NOTE THIS POINT:-- WORSE PROGNOSIS IN ELDERLY
Contd......

NEHRA · Credits: 12123 My Scrapbook

I have posted this question from MRCP level site. A,B,D,E are clear from explanations and I will look for Option "C" in books and net.As soon as I will find I will post it.Discussion is more important and we learn like that more easily.There is/should be no question of ego as this much knowledge we have accumulated is all from books/net and that has been the result of hard work of very senior doctor's and it's not searched by us.So, Please don't take it otherwise anybody

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