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Gastro > Acute Appendicitis > Flashcards

Acute Appendicitis Flashcards

1
Q

What is acute appendicitis?

A

Sudden inflammation of the appendix, usually due to obstruction of the lumen by a faecolith/FB/lymphoid enlargement

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2
Q

What are the symptoms of acute appendicitis?

A 
Periumbilical pain that moves to the RIF (McBurney's point)
Anorexia
Constipation
Diarrhoea (occasional)
Nausea/vomiting (after pain)
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3
Q

What are the signs of acute appendicitis?

A 
Rebound tenderness in RIF
Percussion tenderness
Guarding
Tachycardia
Fever/flushing/fetor
Tender mass (occasionally)
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4
Q

What conditions can commonly mimic acute appendicitis?

A 
Ectopic pregnancy
UTI
Mesenteric adenitis
Diverticulitis
Salpingitis/PID
Dysmenorrhoea
Chron's disease
Perforated ulcer
Food poisoning
Meckel's diverticulitis
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5
Q

What are the special signs seen in appendicitis?

A

Rosving’s sign - pain > in RIF when LIF palpated
Psoas sign - pain on hip extension when retrocaecal appendix
Cope/Obturator sign - pain on flexion/internal rotation of RH if pelvic appendix

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6
Q

What investigations are appropriate in suspected appendicitis?

A 
PREGNANCY TEST
Pelvic exam (in females)
PR
Urinalysis
Bloods 
-FBC- raised 
-U&Es
-CRP/ESR- raised
USS/CT
AXR/CXR
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7
Q

What are the complications of a perforated appendix?

A 
Peritonitis/sepsis
Abscess formation
Appendix mass
Adhesions
Infertility
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8
Q

What is the differential diagnosis for a mass in the RIF?

A 
Inflammatory mass (appendix mass/abscess)
Lymphoma
Chron's
Tumour (caecal/carcinoid)
Pelvic kidney
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9
Q

How should a RIF mass be investigated?

A

USS/CT to confirm diagnosis

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10
Q

How should RIF abscesses be managed?

A

Conservative - IV cefuroxime & metronidazole
If mass does not resolve drain abscess percutaneously
Interval appendectomy after 3mo

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11
Q

What are carcinoid tumours?

A

Tumours of argentaffin cells
Produce sterotonin/prostaglandings
Occur on tip of appendix (MEN-1 syndrome)

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12
Q

How do carcinoid tumours present?

A

> 30yrs
Carcinoid syndrome
-flushing of face
-diarrhoea due to endocrine products

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13
Q

What is the management/prognosis of carcinoid tumours?

A

Tumour resection

Prognosis generally good

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14
Q

What are the early complications of a laparoscopic appendectomy?

A

Haematoma

Wound infections

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15
Q

What is the management of appendicitis?

A

Admit
NBM
Analgesia
IV fluids and abx to prevent wound infections
Appendectomy-urgent
Can give IV abx as alternate treatment if pt does not want surgery

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16
Q

What is the management of an appendicular mass?

A

Omentum surrounds ands sticks to inflamed appendix
Forms a mass in RIF
Managed supportively with IV abx
Elective appendectomy after resolution

Gastro (8 decks)

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