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#Phase 2.1: Peri Op > Acute Appendicitis > Flashcards

Acute Appendicitis Flashcards

1
Q

When is the highest incidence age range for Acute Appendicitis?

A

10-20 years

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2
Q

What is the pathophysiology of Acute Appendicitis?

A

Acute inflamm of appendix bc obstruction of lumen bc:

  1. Faecolith
  2. Impacted (stuck) stool
  3. Lymphoid hyperplasia
  4. Tumour (rare)
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3
Q

What is a faecolith?

A

Hard stony mass of faeces

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4
Q

What is the most common cause of Acute Appendicitis in adults?

A

Faecolith

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5
Q

Why is impacted (stuck) stool a more common cause of Acute Appendicitis in children?

A

Higher rates of constipation

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6
Q

What is a lymphoid hyperplasia?

A

Hyperplasia of the submucosal lymphoid follicles

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7
Q

What is the most common cause of Acute Appendicitis in children?

A

Lymphoid hyperplasia

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8
Q

What is the most common cause of lymphoid hyperplasia?

A

Viral infection

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9
Q

How does lumen obstruction lead to appendicitis and eventually peritonitis? (8 steps)

A
  1. Lumen obstruction
  2. Lumen fills with mucus
  3. Increased intraluminal pressure
  4. Reduced blood flow to appendix
  5. Resident bacteria in appendix multiply (B.fragilis and E.coli)
  6. Inflamm + ischaemia of appendix (appendicitis)
  7. Perforation
  8. Peritonitis
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10
Q

What is the most common presentation of Acute Appendicitis?

A

Abdominal pain

Starts off as dull + poorly-localised peri-umbilical / epigastric pain –> sharper + migrates to RIF within 1-12 hours

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11
Q

Is the abdominal pain in Acute Appendicitis worse on movement?

A

Yeah

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12
Q

What clinical features can you find on examination of a patient of Acute Appendicitis? (3 things)

A
  1. Rebound tenderness
  2. Guarding
  3. Percussion pain

@ McBurney’s Point (2/3 of way between umbilicus & ant. sup. iliac spine)

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13
Q

What clinical features can be seen in SEVERE cases of Acute Appendicitis?

A

Sepsis features

  1. Tachycardia
  2. Hypotension
  3. Appendiceal abcess + RIF mass
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14
Q

What are the specific signs of Acute Appendicitis on examination? (2 things)

A
  1. Rovsing’s Sign
  2. Psoas Sign
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15
Q

What is Rovsing’s Sign?

A

RIF pain @ palpation of LIF

(sign of acute appendicitis)

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16
Q

What is Psoas Sign?

A

RIF pain @ extension of right hip

(sign of acute appendicitis)

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17
Q

What does the Psoas Sign suggest?

A

Inflam appendix touching psoas major muscle in retrocaecal position

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18
Q

What symptoms of Acute Appendicitis can present AFTER the pain?

A
  1. Nausea + vomiting
  2. Anorexia
  3. Low grade fever
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19
Q

If you suspect Acute Appendicitis and patient has HIGH grade fever, what’s up den?

A

It’s probs Peritonitis or stn else cah Acute Appendicitis only has LOW grade fever

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20
Q

What lab investigations should be done for suspected Acute Appendicitis?

A
  1. FBC = reveals neutrophil leucocytosis in 80-90% of cases
  2. CRP = elevated
  3. Urinalysis = to exclude UTI
  4. Pregnancy test = to exclude pregnancy / ectopic pregnancy
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21
Q

Is imaging required for Acute Appendicitis diagnosis?

A

No but useful if other tests inconclusive

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22
Q

What imaging should be done Acute Appendicitis?

A
  1. CT
  2. US
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23
Q

Why is a CT scan useful in Acute Appendicits? (2 things)

A
  1. 94% sensitivity + 95% specificity in acute appendicitis diagnosis
  2. Minimises likelihood of -ve appendicectomy
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24
Q

What is -ve appendicectomy?

A

Appendicectomy in which surgeon discovers there is NO appendicitis

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25
Q

Why is an US scan useful in Acute Appendicits? (2 things)

A
  1. Good first line imaging if radiation is concern (e.g children / pregnant)
  2. Good if suspected gynaecological differentials
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26
Q

What gynaecological conditions present similarly to Acute Appendicitis? (3 things)

A
  1. Ectopic pregnancy
  2. Ovarian torsion
  3. Pelvic inflamm disease
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27
Q

What are the SIMILARITIES between Acute Appendicitis and Ectopic pregnancy? (3 things)

A
  1. RIF pain
  2. Nausea + vomiting
  3. Fever
28
Q

How do you DIFFERENTIATE between Acute Appendicitis and Ectopic pregnancy? (2 things)

A
  1. Ectopic = present w 6-8 wk history of amenorrhoea (absence of periods) +/- vaginal bleeding
  2. Ectopic = +ve pregnancy test
  3. US scan
29
Q

What are the SIMILARITIES between Acute Appendicitis and Ovarian torsion? (2 things)

A
    1. RIF pain
  2. Nausea + vomiting
30
Q

How do you DIFFERENTIATE between Acute Appendicitis and Ovarian torsion? (2 things)

A
  1. Ovarian torsion = palpable adnexal mass (ovary region)
    in 50-70% cases
  2. US scan
31
Q

What are the SIMILARITIES between Acute Appendicitis and Pelvic inflamm disease? (3 things)

A
  1. Lower abdominal pain
  2. Nausea + vomiting
  3. Fever
32
Q

How do you DIFFERENTIATE between Acute Appendicitis and Pelvic inflamm disease? (3 things)

A
  1. Pelvic inflamm disease = bilateral
  2. Pelvic inflamm disease = vaginal / cervical discharge
  3. Pelvic inflamm disease = cervical motion tenderness @ examination
  4. US scan
33
Q

What GI conditions present similarly to Acute Appendicitis? (4 things)

A
  1. Acute mesenteric adenitis (children)
  2. Meckel’s diverticulitis
  3. Inflammatory bowel disease (Crohn’s)
  4. Acute cholecystitis
34
Q

What are the SIMILARITIES between Acute Appendicitis and Acute mesenteric adenitis? (2 things)

A
  1. Lower abdominal pain
  2. Guarding
35
Q

How do you DIFFERENTIATE between Acute Appendicitis and Acute mesenteric adenitis? (2 things)

A
  1. Acute mesenteric adenitis = occurs in children after upper resp tract infection
  2. Acute mesenteric adenitis = does NOT cause localised tenderness
36
Q

What are the SIMILARITIES between Acute Appendicitis and Meckel’s diverticulitis? (2 things)

A
  1. Periumbilical pain –> localises to RIF
  2. Peritonitis
37
Q

How do you DIFFERENTIATE between Acute Appendicitis and Meckel’s diverticulitis?

A

Indistinguishable from each other, only identified once you get a -ve appendicectomy

38
Q

What are the SIMILARITIES between Acute Appendicitis and Inflammatory bowel disease (Crohn’s)? (5 things)

A
  1. Present in young adults
  2. RLQ pain
  3. Fever
  4. Nausea + vomiting
  5. Raised inflamm markers
39
Q

How do you DIFFERENTIATE between Acute Appendicitis and Inflammatory bowel disease (Crohn’s)? (2 things)

A
  1. Crohn’s = chronic diarrhoea
  2. Crohn’s = maybe +ve FHx
40
Q

What are the SIMILARITIES between Acute Appendicitis and Acute cholecystitis? (2 things)

A
  1. Right-sided abdominal pain (+/e guarding)
  2. Raised inflamm markers
41
Q

How do you DIFFERENTIATE between Acute Appendicitis and Acute cholecystitis? (2 things)

A
  1. Acute cholecystitis = pain in RUQ
  2. Palpable gallbladder
42
Q

What Urological conditions present similarly to Acute Appendicitis? (3 things)

A
  1. Testicular torsion
  2. Ureteric stones (right)
  3. UTI
43
Q

What are the SIMILARITIES between Acute Appendicitis and Testicular torsion? (3 things)

A
  1. Abdominal pain
  2. Nausea / vomiting
  3. Presents in children + young adults

Differences: in testicular torsion, there is typically severe testicular pain and testicular oedema

44
Q

How do you DIFFERENTIATE between Acute Appendicitis and Testicular torsion? (2 things)

A
  1. Testicular torsion = severe testicular pain
  2. Testicular torsion = testicular oedema
45
Q

What are the SIMILARITIES between Acute Appendicitis and Ureteric stones (right)? (2 things)

A
  1. Right sided abdominal pain
  2. Nausea / vomiting
46
Q

How do you DIFFERENTIATE between Acute Appendicitis and Ureteric stones (right)?

A

Ureteric stones = pain in flank, colicky, radiates to groin

47
Q

What are the SIMILARITIES between Acute Appendicitis and a UTI? (2 things)

A
  1. Lower abdominal pain
  2. Fever
48
Q

How do you DIFFERENTIATE between Acute Appendicitis and a UTI? (2 things)

A
  1. UTI = Dysuria, urgency, frequency
  2. UTI = older adults
49
Q

What is the gold standard treatment for Acute Appendicitis?

A

Laparoscopic appendicectomy

50
Q

What should patients receive 1 hour prior to Laparoscopic appendicectomy?

What does this do?

A

Prophylactic abx (piperacillin / tazobactam)

Reduces wound infections

51
Q

What should happen to the appendix after Laparoscopic appendicectomy.

A

Sent for histopathology to rule out malignancy (found in 1% cases)

52
Q

How should a patient with a perforated appendix be managed? (2 things)

A
  1. Urgent appendicectomy
  2. Post-op abx
53
Q

How should patients with Acute Appendicitis who are unfit for surgery be managed? (3 things)

A
  1. Analgesia
  2. IV Fluids
  3. IV abx
54
Q

What are the complications of Acute Appendicitis? (4 things)

A
  1. Perforation (most common)
  2. Surgical wound infection
  3. Appendix mass
  4. Appendix abcess
55
Q

Why is perforation a more common complication in young children?

A

Delayed presentation

56
Q

What cause of Acute Appendicitis increases the risk of perforation?

A

Faecolith (hard stony mass of faeces)

57
Q

What reduces the risk of Surgical wound infection in Acute Appendicitis?

A

If surgery done laparoscopically instead of open

58
Q

What is an Appendix Mass?

A

When omentum + small bowel adhere to appendix

59
Q

How does an Appendix Mass present?

A

Tender mass in RIF

60
Q

How is an Appendix Mass diagnosed?

61
Q

How should an Appendix Mass be managed? (2 things)

A
  1. Early surgery
  2. Conservatively - NBM / abx
62
Q

What should be excluded when an Appendix Mass is suspected?

A

Colonic tumour (by laparotomy / colonscopy)

63
Q

What causes an Appendix Abscess? (2 things)

A
  1. Perforated appendix
  2. Unresolved Appendix Mass that enlarges
64
Q

How does an Appendix Abscess present? (3 things)

A
  1. Palpable RIF mass (tender)
  2. Fever
  3. Leucocytosis
65
Q

How should an Appendix Abscess be managed? (2 things)

A
  1. Drainage (surgical / percutaneous) (CT / US guided)
  2. Abx

#Phase 2.1: Peri Op (24 decks)

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