Abdominal Emergencies Flashcards
Peak incidence of appendicitis
10-14 years
Pathology of appendicitis
- obstruction (fecolith, worms)
- infection (Bacteroides, E.coli)
Pathogenesis of appendicitis
- appendix lumen obstructed
- appendix distends from secretions
- increased pressure
- arterial and venous obstruction and ischemia
- enteric bacteria invade and cause inflammation
- gangrene and abscess formation
- peritonitis
Pathological classification of appendicitis
- simple
- suppurative
- gangrenous
- perforated
Mc-Burney’s point
2/3 or the distance from the umbilicus to the anterior superior iliac spine
Clues to gangrenous appendicitis
- history longer than 36 hours
- fever >38.6
- leucocytosis >15 000
Differential diagnosis for gangrenous appendicitis
- gastro-enteritis
- constipation
- UTI
- mesenteric adenitis
- PID
- pneumonia
- primary peritonitis
- intussusception
Complications of appendectomy
- residual sepsis
- instestinal obstruction
- appendiceal stump blowout
Definition of intussusception
Invagination of a portion of the intestine into itself
Describe idiopathic intussusception
Hypertrophy of Peyer’s patches following an upper respiratory tract infection or mild enteritis
Where do most intussusceptions occur?
Distal ileum and ileo-caecal area
Clinical features of intussusceptions
- colocky abdominal pain and vomiting
- abdominal sausage-shaped and motile mass
- red current jelly stools
- rectal examination = bloody mucoid stools
Diagnosis of intussusception
X-ray: soft tissue mass, intestinal obstruction
Barium enema: coil spring
Ultrasound: target/swiss roll
When should pneumatic reduction of intussusception not be attempted?
- established intestinal obstruction
- tender mass
- peritonitis
- advancing sepsis and shock
- massive rectal bleeding
Organisms that cause peritonitis
- pneumococcus
- streptococcus
- gonococcus
(usually monomicrobial in primary peritonitis)
