Acute abdomen

Question 1

most common age for appendicitis

Answer 1

14 yrs

Question 2

pathophys of appendicitis

Answer 2

• Lymphoid hyperplasia -> viral illness, bacterial enterocolitis
  – FB -> worms, faecolith, tumour

Question 3

atypical presentations of appendicitis

Answer 3

• Can have RUQ pain and deranged LFT -> inflamed appex against liver
  
  • Against bladder -> UTI
  • Ilium - ileitis
    Sigmoid -> diarrhoea-like illness

Question 4

what features of hx are uncommon in appendicitis

Answer 4

rectal bleeding - eg meckels diverticulum, intuss
episodic pain

Question 5

why is pain typically periumbilical in early appendicitis, and what makes it “localise”?

Answer 5

Splanchnic nerve is - midgut -> hence periumb
Peritoneum becomes irritated -> then it localises to RIF

Question 6

what exactly is a meckels?

Answer 6

a true diverticulum - it contains all layers of the wall. . usually within 1 m of ileoceacal valve. often contains heterotopic tissue, eg pancreas, gastric, both.

Question 7

sx of meckels, including other complications

Answer 7

uncommon to have sx
but if yes, includes: rectal bleeding, (cloicky abdo pain, N/V) bowel obstruction, diverticulitis

other complications: perforation, tumours

Question 7

how common is meckels?

Answer 7

2% of population (is most common GIT congenital anomaly), but males more likely to develop complx than females

Question 7

what is the pathophys of bleeding meckels diverticulum? and what age group is it more common in?

Answer 7

gastric acid from heterotopic tissue ulcerating adjacent ileum

more common < 5 yrs

Question 8

age group when obstruction in meckels occurs generally

Answer 8

older children, adults

Question 9

how to dx meckels?

Answer 9

depends on sx:
pain = uss/ct (ddx appendicitis)
bleeding = consider scopes, radionuclide scans (far out, that seems a bit much), capsule scope

Question 10

what is the mechanism behind radionuclide scans for meckels?

Answer 10

Tc-99m pertechnetate scan (Meckel scan) can identify ectopic gastric mucosa –> ID’s diverticulum about 90-95% of the time

Question 11

treatment for meckels (if sx)

Answer 11

surgery
-> resect diverticulum +/- ileal induration
and treatment of any complications, eg bowel obstruction

Question 12

what is rovsings sign?

Answer 12

releasing in LIF causing pain in RIF

he doesn’t check rebound in rif due to unnecessary hurt. can do gentle percussion

Question 13

https://magga.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=df7ba788-f368-4012-befc-ae14001a163d –> up to 13:00

Answer 13

ad