Surgery9 UKMLA questions
Appendicitis — UKMLA Revision Notes
Acute appendicitis is the most common surgical emergency, caused by obstruction of the appendiceal lumen leading to distension, ischaemia, and bacterial invasion. It presents with central abdominal pain migrating to the right iliac fossa, anorexia, nausea, and low-grade fever.
Key Facts
- Most common surgical emergency; peak incidence in 10–30 year olds
- Classic presentation: periumbilical pain migrating to RIF (McBurney's point)
- Rovsing's sign: RIF pain on palpation of LIF
- Alvarado score: aids diagnosis (max 10 — score ≥7 suggests appendicitis)
- Perforation risk increases with duration: 16–36 hours significantly raises risk
Investigations
- FBC: raised WBC (neutrophilia)
- CRP: elevated
- Urine dip: exclude UTI/renal colic (haematuria in both)
- USS: first-line in children and women of reproductive age
- CT abdomen/pelvis: most accurate; used if USS inconclusive or perforation suspected
Management
- Appendicectomy: definitive treatment — laparoscopic preferred
- IV antibiotics: co-amoxiclav or cefuroxime + metronidazole perioperatively
- Non-operative management (antibiotics alone): selected uncomplicated cases
- Perforated appendicitis: emergency surgery + IV antibiotics
- Appendix mass: conservative management initially, interval appendicectomy
Related UKMLA Conditions
Mesenteric AdenitisOvarian CystEctopic PregnancyCrohn's Disease