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Surgery.(GIT 3).Appendix > 2. ACUTE APPENDICITIS (Clinical picture and Complications) > Flashcards

2. ACUTE APPENDICITIS (Clinical picture and Complications) Flashcards

1
Q

CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • Type of Patient
  • Clinical picture of typical ( classic ) appendicitis
  • Atypical presentations of acute appendicitis:
  • Acute appendicitis in certain circumstances
  • Clinical picture of complicated acute appendicitis
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2
Q

Type of Patient in CLINICAL PICTURE of ACUTE APPENDICITIS

A

a) Race
b) Diet
c) Occupation
d) Age

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3
Q

Race in Type of Patient in CLINICAL PICTURE of ACUTE APPENDICITIS

A

It affects civilized people more than primitive

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4
Q

The reason why ACUTE APPENDICITIS affects civilized people more than primitive

A

due to low residue diet intake predisposing to constipation

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5
Q

Diet in Type of Patient in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • It affects meat eaters than vegetarians
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6
Q

The reason why ACUTE APPENDICITIS affects meat eaters than vegetarians

A

as high protein diet predisposes to constipation

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7
Q

Occupation in Type of Patient in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Affects sedentary workers more than the active

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8
Q

Age in Type of Patient in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • It’s common in adult life (20-30 years)
  • but no age is immune.
  • Very rare in the 2 extremes of life: Children Old age :
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9
Q

The reason why ACUTE APPENDICITIS is very rare in Children Age in Type of Patient in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • Small appendix

* wide base (no stasis).

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10
Q

The reason why ACUTE APPENDICITIS is very rare in old Age in Type of Patient in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • Senile Atrophic Appendix

* Atrophy of lymphoid tissue.

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11
Q

Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Symptoms

Examination

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12
Q

Symptoms in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  1. Pain :
  2. Nausea rather than vomiting.
  3. Constipation :
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13
Q

Pain in Symptoms in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Onset

Character

Site

Course & duration :

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14
Q

Onset of Pain in Symptoms in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Acute onset

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15
Q

Character of Pain in Symptoms in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • in non obstructive type

* in obstructive type.

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16
Q

Character of Pain in non obstructive type in Symptoms in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • diffuse dull ache
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17
Q

Character of Pain in obstructive type in Symptoms in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

colicky

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18
Q

Site of Pain in Symptoms in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

around the umbilicus (both appendix

and umbilicus are supplied by T10).

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19
Q

Course & duration of Pain in Symptoms in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • Within several hours, the pain starts to localize in the right iliac fossa.
  • It is stabbing or stitching
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20
Q

the reason why the character of pain becomes stabbing or stitching after localization in the righ iliac fossa in Symptoms in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

due to spread of the inflammatory process through the wall of the appendix to affect the parietal peritoneum (somatic pain).

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21
Q

Typical sequence of pain of acute appendicitis

A

Diffuse pain around umbilicus followed by localization in the right iliac fossa

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22
Q

Nausea rather than vomiting in Symptoms in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • Etiology of nausea
  • Vomiting is prominent in obstructive appendicitis.
  • If persistent, it indicates a complication
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23
Q

Etiology of nausea in Symptoms in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  1. Abdominal pain ~~ sympathetic stimulation ~~ pyloro spasm ~~ nausea and mild vomiting
  2. Any GIT upset ~~ stimulation of enterochromaffin cells ~~ serotonin ~~ stimulate CTZ ~~ nausea and vomiting
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24
Q

Etiology of persistent vomiting in complicated appendicitis by Mass or abscess

A

Inflammation ~~ paralytic ileus

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25
Q

Constipation in Symptoms in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Rule out crohn’s, carcinoid tumour

It’s a Cause rather than sequelae

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26
Q

Chromaffin cells

A

in adrenal medulla

secretes Epinephrine and norepinephrine

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27
Q

Enterochromaffin

A

secretes serotonin

origin of carcinoid tumour

28
Q

Enterochromaffin-like cells

A

secretes histamine ~~ HCL

29
Q

Examination in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

General

Local

30
Q

General Examination in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  1. Temperature

2. Tachycardia corresponding to fever.

31
Q

Temperature in General Examination in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Normal or Slight rise of temperature (37.2 - 38 degree C).

N.B : High fever arouses suspicion of peritonitis or abscess formation.

32
Q

Local Examination in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

(1) Localized tenderness at McBurney’s point.
(2) Rebound tenderness at McBurney’s point :
(3) Rovsing’s sign
(4) Blumberg’s sign
(5) Sherren’s triangle of hyperaesthesia :
(6) Baldwing’s sign

33
Q

place of McBurney’s point

A

At the junction of the medial 2/3 and lateral 1/3 of a line between ASIS and umbilicus

34
Q

Rebound tenderness at McBurney’s point in Local Examination in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Pain exaggerated over McBurney’s point on sudden

release of pressure by the hand or coughing

35
Q

Rovsing’s sign in Local Examination in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Crossed tenderness

  • Pressure on left iliac fossa causes pain felt in right iliac fossa (due to displacement of the gas inside the colon to caecum distending it & appendix, exaggerating the pain).
  • Not present in every case.
36
Q

Blumberg’s sign in Local Examination in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Crossed rebound tenderness

Indicate pelvic peritonitis rebound tenderness on both sides

37
Q

Sherren’s triangle of hyperaesthesia in Local Examination in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

It is triangle bounded by symphysis pubis, umbilicus & A.S.I.S.

38
Q

Baldwing’s sign in Local Examination in Clinical picture of typical ( classic ) appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Straight leg raising sign

Raising straight the Rt. L.L causes pain due to pressure on the Rt. Iliac fossa.

39
Q

Muscle guarding or rigidity over right iliac fossa denotes

A

Appendicular mass or abscess or perforation is about to occur, or has occurred.

40
Q

Atypical presentations of acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

(1) Long retrocaecal appendix :
(2) Pelvic appendicitis:
(3) Subhepatic appendicitis :
(4) Postileal appendicitis :

41
Q

Long retrocaecal appendix in Atypical presentations of acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Tenderness over the right iliac fossa

If the appendix is in relation to ureter

If appendix is in contact with the psoas muscle (Psoas sign)

42
Q

Tenderness over the right iliac fossa in Long retrocaecal appendix in Atypical presentations of acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

may be minimal and elicited on deep palpation.

43
Q

If the appendix is in relation to ureter in Long retrocaecal appendix in Atypical presentations of acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

pain simulating ureteric colic will be misleading.

44
Q

Psoas sign in Long retrocaecal appendix in Atypical presentations of acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • If appendix is in contact with the psoas muscle, psoas spasm may be sufficient to cause flexion of the hip joint.
  • Extension of the hip causes abdominal pain.
45
Q

Pelvic appendicitis in Atypical presentations of acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Symptoms related to the rectum or to the bladder

Tenderness

Zachary Cope sign :

46
Q

Symptoms related to the rectum or to the bladder in Pelvic appendicitis in Atypical presentations of acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

symptoms related to the rectum as tenesmus & diarrhea

symptoms related to the bladder as frequency of micturation

47
Q

Tenderness in Pelvic appendicitis in Atypical presentations of acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Absence of tenderness over McBurney’s point.

Tenderness can be elicited on P.R. & P.V.

48
Q

Zachary Cope sign in Pelvic appendicitis in Atypical presentations of acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • If the appendix is in relation to the obturator internus muscle, spasm of the muscle causes flexion & external rotation of the hip.
  • So internal rotation of the flexed thigh will cause
    abdominal pain.
49
Q

Subhepatic appendicitis in Atypical presentations of acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Picture of acute cholecystitis

50
Q

Postileal appendicitis in Atypical presentations of acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • Diarrhea.

* Portal pyaemia.

51
Q

Pathogenesis of Diarrhea in Postileal appendicitis in Atypical presentations of acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Due to irritation ~~ mucus secretion

52
Q

Pathogenesis of Portal pyaemia in Postileal appendicitis in Atypical presentations of acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Thrombophlebitis of iliocolic vein of the ileocolic vein leading to portal pyaemia.

53
Q

Acute appendicitis in certain circumstances in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  1. Acute appendicitis in children
  2. Acute appendicitis in old age
  3. Acute appendicitis in pregnancy
54
Q

Pathogenesis of Acute appendicitis in children in Acute appendicitis in certain circumstances in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • Rapid perforation

* Misdiagnosed as gastroenteritis.

55
Q

Pathogenesis of Rapid perforation in Acute appendicitis in children in Acute appendicitis in certain circumstances in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Less developed omentum

56
Q

Pathogenesis of Acute appendicitis in old age in Acute appendicitis in certain circumstances in CLINICAL PICTURE of ACUTE APPENDICITIS

A
  • Gangrene & perforation are more frequent
  • Delay in diagnosis because of subtle symptoms
  • Mimics subacute I.O leading to enema & perforation.

Cancer caecum should be suspected Due to obstruction not infiltration

57
Q

Pathogenesis of Gangrene & perforation in Pathogenesis of Acute appendicitis in old age in Acute appendicitis in certain circumstances in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Gangrene & perforation are more frequent due to

atherosclerosis & weakness of the immune system

58
Q

Pathogenesis of Acute appendicitis in pregnancy in Acute appendicitis in certain circumstances in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Pain & tenderness are higher up.

Liable to perforation without localization

Misdiagnosed as pyelonephritis.

59
Q

Pathogenesis of increased liability to perforation without localization in Pathogenesis of Acute appendicitis in pregnancy in Acute appendicitis in certain circumstances in CLINICAL PICTURE of ACUTE APPENDICITIS

A

as the omentum is elevated.

60
Q

CLINICAL PICTURE of complicated acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

(1) Acute appendicitis with peritonitis :
(2) Acute appendicitis with a mass :
(3) Appendicular abscess :

61
Q

Clinical picture of Acute appendicitis with peritonitis in CLINICAL PICTURE of complicated acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

Tenderness and rebound tenderness all over abdomen

Absolute constipation

62
Q

Clinical picture of Acute appendicitis with a mass in CLINICAL PICTURE of complicated acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

a. Recent history of acute appendicitis 2-3 days before.
b. Constitutional manifestations of infection.
c. Frequent vomiting
d. The mass is firm, tender with ill-defined edge
e. Overlying muscle guarding.
f. Leucocytosis.

63
Q

The reason why we can’t palpate the mass easily in Acute appendicitis with a mass in CLINICAL PICTURE of complicated acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

due to Overlying muscle guarding

64
Q

Clinical picture of Appendicular abscess in CLINICAL PICTURE of complicated acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS

A

a. a. Recent history of acute appendicitis 5 days before.
b. The pain increases and becomes throbbing.
c. Persistent vomiting.

d. The temperature becomes hectic.
e The abscess may be pelvic & is best felt P.R. or P.V. as a tender pelvic mass.

f. Marked leucocytosis.

65
Q

in Clinical picture of Appendicular abscess in CLINICAL PICTURE of complicated acute appendicitis in CLINICAL PICTURE of ACUTE APPENDICITIS , pointing is indicated by

A

Oedema of the overlying rectal or vaginal mucosa

66
Q

COMPLICATIONS OF ACUTE APPENDICITIS

A
  1. Appendicular mass & abscess formation.
  2. Perforation )> Localized or generalized peritonitis
  3. Resolution )> Recurrent appendicitis.
  4. Thrombophlebitis of the ileo-colic vein in post-ileal lie resulting in portal pyaemia ( very rare ).

Surgery.(GIT 3).Appendix (3 decks)

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