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Appendicitis

Appendicitis-pen
Picmonic
Appendicitis is inflammation of the appendix due to obstruction of the appendiceal lumen, which then becomes infected. It presents with peri-umbilical pain that then becomes right lower quadrant pain. Clinical findings include rebound tenderness, positive psoas sign and pain at McBurney's point. Patients are leukocytic and have fever. Curative treatment is appendectomy.
10 KEY FACTS
MECHANISM AND CHARACTERISTICS
Fecolith leading to obstruction and infection
Fecal-monolith Obstructing door and Bacteria

Fecal matter can become lodged in the lumen of the appendix leading to obstruction and infection. Obstruction can also occur due to adhesions, enlarged lymph nodes, foreign bodies, parasites etc.

Most commonly affects teenagers
#1 Foam-finger Teenagers

Appendicitis is most common in teenagers. Males are affected slightly more than females.

PRESENTATION
Initial peri-umbilical visceral pain
Initial Pear-umbrella with Visor Pain-bolts

Pain associated with appendicitis starts off in the peri-umbilical area due to distention of the appendix. This stimulates visceral afferent nerves at the T8-T10 level of the spine causing peri-umbilical pain.

Subsequent somatic right lower quadrant pain
Subsequent Sumo-tick causing RLQ Pain-bolts

As the inflammatory process continues, irritation of more local somatic fibers occurs leading to right lower quadrant pain.

DIAGNOSIS
Rebound tenderness
Rebounding Tenderizer

Rebound tenderness on physical exam signifies peritoneal irritation.

Positive psoas sign
Positive Sewn-ass

This is pain when the patient flexes his/her right hip against resistance. This is specific but not sensitive for appendicitis.

Pain at McBurney's point
Pain-bolt at Mc-Barney

This is located 1/3 of the distance from the anterior superior iliac spine to the umbilicus. This is the location of the base of the appendix.

Leukocytosis
Luke-side-toe

Elevated white blood cell count is seen due to response to infection.

Fever
Fever-beaver

Fever is seen due to response to infection.

TREATMENT
Appendectomy
Appendix-pen cut off by scalpel

Removing the appendix is the gold standard treatment for appendicitis.

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