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Surgery.(GIT 3).Appendix > 3. ACUTE APPENDICITIS (Investigations and Treatment) > Flashcards

3. ACUTE APPENDICITIS (Investigations and Treatment) Flashcards

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1
Q

INVESTIGATIONS OF ACUTE APPENDICITIS

A
  • Indications
  • Laboratory
  • Radiological
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2
Q

Indications of INVESTIGATIONS OF ACUTE APPENDICITIS

A

Acute appendicitis is a clinical diagnosis & lnvestigations are done to exclude other causes of acute abdomen

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3
Q

Laboratory INVESTIGATIONS OF ACUTE APPENDICITIS

A
  1. CBC

2. Urine analysis.

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4
Q

CBC in Laboratory INVESTIGATIONS OF ACUTE APPENDICITIS

A
  • Moderate leucocytosis with predominance of neutrophils.

* its value In the early phase

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5
Q

value of CBC In the early phase in Laboratory INVESTIGATIONS OF ACUTE APPENDICITIS

A

In the early phase it is of no great diagnostic value

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6
Q

the reason why In the early phase CBC is of no great diagnostic value in Laboratory INVESTIGATIONS OF ACUTE APPENDICITIS

A
  • it is not marked leucocytosis or normal

* Normal TLC doesn’t exclude acute appendicitis.

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7
Q

Radiological INVESTIGATIONS OF ACUTE APPENDICITIS

A
  1. Pelvi-abdominal U.S

2. CT scan.(Recently)

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8
Q

Pelvi-abdominal U.S in Radiological INVESTIGATIONS OF ACUTE APPENDICITIS

A

Findings

Advantages:

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9
Q

Findings of Pelvi-abdominal U.S in Radiological INVESTIGATIONS OF ACUTE APPENDICITIS

A

In few cases, the inflamed appendix appears distended & non-compressible.

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10
Q

Advantages of Pelvi-abdominal U.S in Radiological INVESTIGATIONS OF ACUTE APPENDICITIS

A
  • To exclude gynecological causes.

* Helpful for diagnosis of appendicular mass.

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11
Q

Findings of CT scan (Recently) in Radiological INVESTIGATIONS OF ACUTE APPENDICITIS

A

Edema of the wall

Enhancement in wall ( takes much dye)

Fluid collection around the appendix

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12
Q

TREATMENT of ACUTE APPENDICITIS

A

A. Treatment of uncomplicated acute appendicitis

B. Treatment of appendicular mass

C. Treatment of appendicular abscess

D. Treatment of acute appendicitis with peritonitis

E. Treatment of acute appendicitis with portal pyaemia

F. Treatment of acute appendicitis in special circumstances

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13
Q

indication of medical treatment of acute catarrhal appendicitis by antibiotics

A

to delay the surgical operation due to an upcoming exam

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14
Q

A. Treatment of uncomplicated acute appendicitis in TREATMENT of ACUTE APPENDICITIS

A
  • Appendicectomy.

* EUA is must to exclude appendicular mass

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15
Q

Treatment of appendicular mass in TREATMENT of ACUTE APPENDICITIS

A

Appendicectomy is not advisable

Regimen: “ ochsner- sherren” regimen

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16
Q

The reason why Appendicectomy is not advisable in Treatment of appendicular mass in TREATMENT of ACUTE APPENDICITIS

A

a. Dissection of the appendix is difficult.

b. Serious complications may follow as bowel injury ( faecal fistula )

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17
Q

” ochsner- sherren” regimen in Treatment of appendicular mass in TREATMENT of ACUTE APPENDICITIS

A
  • General management
  • Local management
  • Meticulous observation
  • Outcomes of the regimen
18
Q

General management in “ ochsner- sherren” regimen in Treatment of appendicular mass in TREATMENT of ACUTE APPENDICITIS

A

a. Rest in semi-sitting position :
b. Broad spectrum antibiotics.
c. Analgesics for pain.

19
Q

the reason why Rest is in semi-sitting position in General management in “ ochsner- sherren” regimen in Treatment of appendicular mass in TREATMENT of ACUTE APPENDICITIS

A
  • To relax anterior abdominal wall.
  • The pelvis is lowermost so that if perforation occurs, it drains directly in this part which is a localized poorly vascular area (causing mild & not severe toxaemia).
20
Q

Local management in “ ochsner- sherren” regimen in Treatment of appendicular mass in TREATMENT of ACUTE APPENDICITIS

A
  1. Marking the mass to follow up its size.
  2. Rest of GIT :
  3. Hot fomentations on the mass.
21
Q

Rest of GIT in Local management in “ ochsner- sherren” regimen in Treatment of appendicular mass in TREATMENT of ACUTE APPENDICITIS

A
  • No oral feeding for 48 hours & IV fluids.

* Ryle tube insertion & nasogastric aspiration

22
Q

Hot fomentations on the mass in Local management in “ ochsner- sherren” regimen in Treatment of appendicular mass in TREATMENT of ACUTE APPENDICITIS

A

This flushes the area with blood carrying antibodies & macrophages

23
Q

Meticulous observation in Local management in “ ochsner- sherren” regimen in Treatment of appendicular mass in TREATMENT of ACUTE APPENDICITIS

A
  1. Severity of pain & vomiting.
  2. Temperature & pulse.
  3. Tenderness, size of mass & rigidity.
  4. TLC.

These should be recorded on a chart.

In the first 2 days, Observation should be close, even hourly & later every 4 hours.

24
Q

Outcomes of the “ ochsner- sherren” regimen in Treatment of appendicular mass in TREATMENT of ACUTE APPENDICITIS

A

Further Management of The great majority of cases who will resolve under this line of treatment.

or

Signs of Failure of conservative Treatment indicating abscess

25
Q

Further Management of The great majority of cases who will resolve under this line of treatment. in Outcomes of the “ ochsner- sherren” regimen in Treatment of appendicular mass in TREATMENT of ACUTE APPENDICITIS

A
  • Continue medical treatment till the mass disappears completely (2 weeks)
  • Patient is sent home
  • Appendicectomy is done after 3 months “Interval appendicectomy
26
Q

Signs of Failure of conservative Treatment in Outcomes of the “ ochsner- sherren” regimen in Treatment of appendicular mass in TREATMENT of ACUTE APPENDICITIS

A
  1. Persistent vomiting
  2. Throbbing pain
  3. Rising pulse rate.
  4. Hectic fever.
  5. Increasing mass size
  6. Increasing TLC.

All of the above indicates abscess formation

27
Q

The reason why Examination under Anaesthesia (E.U.A) before starting appendicectomy is essential.

A

as Sometimes overlying muscular rigidity renders an appendicular mass indefinite or even impalpable.

28
Q

If appendicular mass is discovered after opening the peritorueum,

A

put a drain & close the abdomen & follow conservative treatment

29
Q

Treatment of appendicular abscess in TREATMENT of ACUTE APPENDICITIS

A

Extraperitoneal drainage via muscle cutting incision

Interval appendicectomy is done after 6 months.

30
Q

The reason why The defect of drainage disappears by time in Extraperitoneal drainage via muscle cutting incision in Treatment of appendicular abscess in TREATMENT of ACUTE APPENDICITIS

A

It will be covered by fibrous tissue by the help of the covered omentum and peritoneum in the next 6 month until the interval appendicectomy is done

31
Q

The reason why muscle cutting incision is done in Extraperitoneal drainage via muscle cutting incision in Treatment of appendicular abscess in TREATMENT of ACUTE APPENDICITIS

A

To allow good drainage of pus

32
Q

Disadvantage of muscle cutting incision that is done in Extraperitoneal drainage via muscle cutting incision in Treatment of appendicular abscess in TREATMENT of ACUTE APPENDICITIS

A

incisional hernia

33
Q

Treatment of acute appendicitis with portal pyaemia in TREATMENT of ACUTE APPENDICITIS

A
  • Appendicectomy with ligation of ileo-colic vein under antibiotic cover should be performed immediately.
  • Bad prognosis
34
Q

Prognosis of Appendicectomy with ligation of ileo-colic vein under antibiotic cover in Treatment of acute appendicitis with portal pyaemia in TREATMENT of ACUTE APPENDICITIS

A

Bad prognosis

35
Q

Treatment of acute appendicitis in special circumstances in TREATMENT of ACUTE APPENDICITIS

A

Treatment of acute appendicitis in

1- Last trimester of pregnancy:

2- Children:

  1. Old age
36
Q

Treatment of acute appendicitis in Last trimester of pregnancy in TREATMENT of ACUTE APPENDICITIS

A

Urgent appendicectomy

37
Q

The reason why urgent appendicectomy is done in Treatment of acute appendicitis in Last trimester of pregnancy in TREATMENT of ACUTE APPENDICITIS

A

because the omentum being displaced upwards with the gravid uterus, so no tendency to localization

38
Q

Treatment of acute appendicitis in Children in TREATMENT of ACUTE APPENDICITIS

A

Urgent appendicectomy

39
Q

The reason why urgent appendicectomy is done in Treatment of acute appendicitis in Children in TREATMENT of ACUTE APPENDICITIS

A

due to short not well developed omentum so no localization is expected to occur.

40
Q

Treatment of acute appendicitis in old age in TREATMENT of ACUTE APPENDICITIS

A

Urgent appendicectomy

41
Q

The reason why urgent appendicectomy is done in Treatment of acute appendicitis in old age in TREATMENT of ACUTE APPENDICITIS

A

because gangrene is rapid to occur due to atherosclerotic vessels.

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

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