Appendicitis

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This is characterised by inflammation of the appendix, and usually requires urgent surgical  intervention. 

Clinical presentation 

  • Sudden peri-umbilical pain often migrating to the right iliac fossa
  • Nausea and vomiting
  • Loss of appetite
  • Fever
  • Constipation or occasionally diarrhea
  • Bloated abdomen
  • Rebound tenderness
  • Guarding and rigidity
  • Right iliac fossa tenderness
  • Right iliac fossa rebound pain
  • Severe persistent abdominal pain

Investigations 

  • FBP
  • Urinalysis
  • Pregnancy test in females
  • LFT
  • Lipase/amylase excludes pancreatitis
  • Abdominal USS
  • CT scan

Complications 

  • Perforation/peritonitis
  • Appendicular abscess
  • Appendicular mass

Pharmacological management 

B: ceftriaxone (IV) 1g 12hourly for 5-7days 

AND 

B: metronidazole (IV) 500mg 8hourly for 5-7days 

AND 

A: diclofenac (IM) 75mg 8hourly for 3days