13. What are the three positions in which the appendix can lie?
Correct answer: (1) Distally the tip may lie anywhere from behind the caecum (retrocaecal); (2) adjacent to the ileum, or (3) down in the pelvis lying against the rectum or bladder.
12. What is the nature of the pain of acute appendicitis?
Correct answer: Typically the pain commences as a central periumbilical colic, which shifts after approximately 6 hours to the right iliac fossa or, more accurately, to the site of the inflamed appendix as the adjacent peritoneum becomes inflamed. The appendix…
11. How do patients with acute appendicitis typically present?
Correct answer: The vast majority of patients with acute appendicitis present with marked localized pain and tenderness in the right iliac fossa.
10. What is the pathological course of acute appendicitis?
Correct answer: The acutely inflamed appendix may resolve, but if so a further attack is likely. It is not uncommon for a patient with acute appendicitis to confess to one or more previous milder episodes of pain, the ‘grumbling appendix’….
9. Can appendicitis occur in a non-obstructed appendix? How?
Correct answer: Occasionally, appendicitis can occur in the non-obstructed appendix. Here there may be a direct infection of the lymphoid follicles from the appendix lumen, or in some cases the infection may be haematogenous (e.g. the rare streptococcal appendicitis). The…
7. What happens when an empty appendix is obstructed?
Correct answer: A mucocele will form, because of continued secretion of mucus from the goblet cells in the mucosal wall.
6. How long do the pathological changes of appendicitis take to develop once obstruction of the appendix has occurred?
Correct answer: There is no strict time relationship for this chain of events. An appendix may occasionally perforate under 12 hours, but conversely it is not rare to see an acutely inflamed but not perforated appendix after 3 or 4…
5. Which artery supplies the appendix?
Correct answer: Branches of the appendicular branch of the ileocolic artery.
4. What happens to the appendix once it has been obstructed?
Correct answer: The obstructed appendix acts as a closed loop; bacteria proliferate in the lumen and invade the appendix wall, which is damaged by pressure necrosis. The vascular supply to the appendix is made up of end-arteries, which are branches…
