Appendix MCQs

Ultra-clean ventilation systems use high-efficiency particulateair (HEPA) filters that remove 99.9% of particulate matter >0.3 mm in diameter (bacteria are 0.5 mm). They also use vertical laminar airflow over the operating table to minimise turbulence, reduce contamination at the surgical site (horizontal laminar air flow is less effective (Salvati et al . 1982)). Laminar airflow theatres have an air exchange every 2-3 minutes. Reference : Love & Bailey short practice of surgery, Appendix: 1, Edition: 27 th , Pg: 1563

The operating lights disturb the laminar airflow and are optimally placed to either side of the operative wound with 0.6 m between the lights to minimise obstruction to the vertical airflow (Refaie et al . 2015). Temperature in the operating theatre should be between 18 and 25°C. Reference : Love & Bailey short practice of surgery, Appendix: 1, Edition: 27th, Pg: 1564

Aside from its tendency to cause surgical pathology the appendix, long thought to be a vestigial organ, may also have important roles in both immune function and maintaining the gut microbiota. The putative role of the appendix in the pathogenesis of ulcerative colitis (appendicectomy seems to be protective) for example, may be explained by its interaction with the intestinal flora and gut immune function. Reference: Bailey & Love's short practice of surgery, chapter 76, Edition 28th, Pg: 1335

Deep palpation of the left iliac fossa may cause pain in the right iliac fossa, Rovsing's sign, which is helpful in supporting a clinical diagnosis of appendicitis. Occasionally, an inflamed appendix lies on the psoas muscle, and the patient, often a young adult, will lie with the right hip flexed for pain relief (the psoas sign). Spasm of the obturator internus is sometimes demonstrable when the hip is flexed and internally rotated. If an inflamed appendix is in contact with the obturator internus, this manoeuvre will cause pain in the hypogastrium (the obturator test; Zachary Cope). Cutaneous hyperaesthesia may be demonstrable in the right iliac fossa, but is rarely of diagnostic value. Reference: Bailey & Love's short practice of surgery, chapter 76, Edition 28th, Pg: 1339

Retrocaecal Rigidity is often absent, and even application of deep pressure may fail to elicit tenderness (silent appendix), the reason being that the caecum, distended with gas, prevents the pressure exerted by the hand from reaching the inflamed structure in case of retrocaecal appendix. However, deep tenderness is often present in the loin, and rigidity of the quadratus lumborum may be in evidence. Psoas spasm, due to the inflamed appendix being in contact with that muscle, may be sufficient to cause flexion of the hip joint. Hyperextension of the hip joint may induce abdominal pain when the degree of psoas spasm is insufficient to cause flexion of the hip. Reference: Bailey & Love's short practice of surgery, chapter 76, Edition 28th, Pg: 1339

The appendicular artery, a branch of the lower division of the ileocolic artery , passes behind the terminal ileum to enter the mesoappendix a short distance from the base of the appendix.