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Surgical Diseases MCQs > Acute Abdomen (appedicitis) > Flashcards

Acute Abdomen (appedicitis) Flashcards

1
Q

What is acute abdomen?

A

Signs and symptoms of abdominal pain and tenderness. A clinical presentation that often requires emergency surgical therapy.

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2
Q

Most common surgical acute abdominal conditions, presented with acute abdomen:

aka: most common acute abdominal conditions

A

Abdominal organs infections (appedicitis, cholecystitis, Meckel’s Diverticulum)

Abdominal organs ischemia (Buergers dieases, strangulated hernia)

intra-abdominal haemorrhage (solid organ trauma, ruptured ectopic pregnancy, arterial aneurysms)

gastro-intestinal perforations (ulcer, cancer, diverticulum)

ileus

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3
Q

What Examinations need to be done to establish acute abdomen?

A

Medical History
Physical Exam (inspection, palpation, percussion, auscultation)
Lab tests
Imaging studies

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4
Q

Most common general surgical emergency

A

Acute appendicitis

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5
Q

Def of Acute Appendicitis

A

acute inflammation of appendix

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5
Q

Positions of appendix in relation to caecum?

A

medial, retrocecal, laterocecal, subhepatic, tip
close to left colon, pelvic

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5
Q

How does history of acute appendicitis begin:

A

central abdominal pain of a visceral type (illlocalised, usually around umbilicus or epigastrium

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6
Q

Causes of acute appendicitis

A

obstruction of the appendiceal lumen due to:
- lymphoid tissue hyperplasia (60%)
- Fecalith and fecal stasis (35%)
- Neoplasm
-Parasitic infections: Enterobius vermicularis, Ascaris lumbricoides

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7
Q

Pathophysiology of Appendicitis

A

obstructed proximal appendiceal lumen (is a type of closed loop obstruction) results in:
1. stasis of mucosal secretions
2. bacterial mutliplication and local inflammation
3. transmural spread of infection
4. clinical signs of appendicitis

OR

increased intraluminal pressure which obstructs veins
1. oedema of appendicial walls
2. obstruciton of cappilaries
3. ischemia
4. gangrenous appendicitis w or w\o perforation

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8
Q

Non specific sx of appendicitis:

A

nausea
vomiting
low grade fever
diarrhoea -> secondary to ileal irritation
constipation -> due to paralytic ileus
anorexia in 80% of cases tested with hamburger sign

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9
Q

What is Hamburger sign?

A

Pt asked if they want their favourite food if they accept it is unlikely for appendicitis and other Dx should be looked at

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10
Q

Most sensitive signs of acute appendicitis accompanying with local peritoneal irritation:

A

Right lower abdominal quadrant pain (somatic phase of pain)

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11
Q

Most common abdominal physical findings in acute appendicitis:

A

local tenderness and
guarding in the RLQ

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12
Q

. Hallmark in the diagnosis acute abdomen:

A

tenderness over the site of appendix

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13
Q

Management of acute appendicitis:

A

Appendectomy

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14
Q

Periappendicular infiltrate is:

A

host defense reaction against spreading of inflammation from appendix into peritoneal cavity

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15
Q

Clincal Signs of Appendicitis:

A

McBurney’s sign: point tenderness in RLQ in location of appendix à between ASIS and umbilicus

o RLQ guarding and/or rigidity

o Rebound tenderness (Blumberg sign) -> especially in the RLQ

o Rovsing sign: RLQ pain elicited on deep palpation of the LLQ

o Psoas sign: RLQ pain may be elicited on passive extension of the right hip. Indicates iliopsoas irritation secondary to an inflamed retrocecal appendix

o Obturator sign: RLQ pain on passive internal rotation of the right hip with the hip and knee flexed pelvic appendix

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16
Q

DDx of Acute Appendicitis:

A
  • Gynaecological: ovarian cyst rupture, ectopic pregnancy, pelvic inflammatory disease
  • Renal: ureteric stones, urinary tract infection, pyelonephritis
  • Gastrointestinal: mesenteric adenitis, diverticular disease, IBD, or Meckel’s diverticulum
    o If a normal appendix is found during appendicectomy look for an inflamed Meckel’s diverticulum
  • Urological: testicular torsion, epididymo-orchitis
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16
Q

Tx for Acute Appendicitis

A

Supportive: IV fluids, electrolytes, IV analgesics, antipyretic therapy

Antibiotic therapy for all pt against gr -ve and anaerobic bacteria

Surgery

Nonoperative managment

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16
Q

What are benefits of open appendectomy over laparoscopic? Disadavanatages?

A

cheaper, lower rates of intrabdominal absecess

higher wound infection rate, greater post op pain and recovery period

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17
Q

Dx of Acute Appendicitis:

A
  • Urinalysis: rule out renal or urological cause. Females pregnancy test also imp
  • Bloods: FBC, CRP, beta hCG if ectopic pregnancy still not excluded
  • Imaging: US first line (transvaginal)
  • CT with contrast
  • MRI w\wo contrast
17
Q

When is diagonstic laparoscopy used in acute appendicits?

A

used for Dx and Tx in:
- women of reproductive age
- pt over 65
- obese pt

17
Q

Surgical Tx for Acute appendicits

A

done right after Dx or withing 24hrs after dx (delayed appendectomy)

Laparoscopic or open appendectomy

17
Q

Contraindications for appendectomy:

A

pt with appendiceal abscess or inflammatory appendiceal mass has increased risk of intraoperative hemorrhage, post op wound infection, fecal fistula formation

18
Q

Non operative managemnet for acute appendicitis:

A

antibiotic therapy for 2-3 days
supportive caare
image guided percutaneous drainage if there is periappendiceal abcess >4cm

19
Q

Why is acute appendicitis harder to Dx in older pt?

A

pt delay seeking care and presentation may be atypical leading to more frequent perforation of appendix

20
Q

What is the characteristic pain in eldery pt appendicitis?

A

lower abdominal pain however RLQ pain not as common.

21
Q

Sx of appendicitis in eldery?

A

chronic and atypical
confusion
possible low grade fever
subtle abdominal guarding due to weaker abdominal muscles

22
Q

DDx of acute appendicitis in eldery?

A

o Pyelonephritis ->flank pain + ↑fever, Pyuria, ↑WBC

o Colitis -> Diarrhea with pain localised by the pathway of the colon

o Diverticulitis ->Rt sided pain is insidious, worsening over a period of days and involves a larger area of tenderness in the RLQ than appendicitis

o Malignancies of GI or reproductive tract

o Perforated ulcers

o Cholecystitis

23
Q

Dx of appendicitis in elderly

A

CT, if imaging inconclusive use diagnostic laparotomy

24
Q

Why is appendicitis difficult to dx during pregnancy?

A

appendix is displaced superiorly by gravid uterus after 2nd trimester and takes position in RUQ or epigastrium making it mistaken as pyelonephritis or cholecystitis

abdominall wall is lifted from appendix by gravid uterus so peritoneal irritation by appendix few than in non pregnant women

leucocytosis is normal in prgnancy

25
Q

What Dx technique is used pregnant women with query appendicitis?

A

US

26
Q

Why is it difficult to Dx appendicits in children?

A

they cant give accurate history or properly describe their pain

underdevlpoed greater omentum and immune system perforation causes a much faster spread and more fatal

there may be vomitins, fever, leucocytosis

27
Q

DDx of appendicitis in children?

A

Meckel’s diverticulitis, intussusception and acute gastroenteritis

28
Q

Def Meckel’s diverticulum:

A

: true diverticulum of variable size derived from intestinal remnant of
yolk stalk/omphalomesenteric duct

congenital malformation of GIT, remnant of omphalomesenteric duct

29
Q

Localisation of Meckel’s diverticulum:

A

antimesenteric border of the terminal ileum,
approximately 40-50cm from ileocecal valve in adults

30
Q
  1. Complications of Meckel’s diverticulum:
A

GI bleeding, perforation, small intestinal obstruction, diverticulitis, enteroliths, foreign bodies into diverticulum

31
Q

Def Crohn;s disease

A

chronic transmural inflammatory disease of the GIT causes inflammation and irritation due to an unknown cause

32
Q

What Part of the alimentary tract is most commonly involved in Crohn’s disease:

A

small intestine and colon

33
Q

Stages of Crohn’s disease

A

a. Acute: transmural abscesses and perforation of intestinal wall
b. Subacute: granulomas and ulcers onto the intestinal mucosa are produced
c. Chronic: fibrotic transformation of intestine wall

34
Q

Most common clinical presentation in acute stage of Crohn’s disease:

A

abdominal pain (most
frequent), then melena/diarrhea with blood (because of mucosal ulcers)

35
Q

Complications of Crohn’s disease:

A

significant intestinal bleeding, acute peritonitis (small
intestine perforation), bowel obstruction, intestine fistula

36
Q

Non surgical cause of acute abdomen:

A

diabetic crisis

37
Q

What is Murphy’s sign

A

Murphy’s sign is a physical examination maneuver used to differentiate pain in the right upper quadrant.0 It is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.12 However, it is negative in choledocholithiasis, pyelonephritis, and ascending cholangitis.

38
Q

Most common non-obstetric disease requiring surgery in pregnant women:

A

appendicitis

39
Q

When diagnosis a child with acute abdomen we consider appendicitis as one of the primary
causes. Which of the following diseases should we include in the differential diagnosis:

A

perforation from foreign body ingestion and intussusception

40
Q

Cardiopulmonary bypass has been associated with which if the following acute abdominal
illnesses
a. Paralytic ileus
b. Mesenteric ischemia
c. Stress peptic ulceration
d. Ogilvie syndrome
e. All of the above

A

all the above

41
Q

Which of the following signs is typical for acute appendicitis
a. Kehr sign
b. Charcot sign
c. Murphy sign
d. Rovsing sign
e. Chandeller sign

A

rovsign

42
Q

In the beginning patients presenting with acute appendicitis typically complain of:

A

vague
abdominal pain that is most commonly periumbilical in origin

43
Q

. What is the treatment of delayed presentation of appendicitis (Periappendicular infiltrate):

A

non-operative (antibiotics and bed rest)

Surgical Diseases MCQs (4 decks)

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