Acute Appendicitis Flashcards
1
Q
- most common emergency general surgical disease affecting the abdomen
- occurs most commonly in 10- to 19-year-old
- 70% of patients are <30 years old
- most are men
- perforation
+ most important causes of excess morbidity and mortality
+ 20%- higher in patients under 5 or over 65 years of age
A
Appendicitis
2
Q
CLINICAL MANIFESTATIONS OF APPENDICITIS
What is the classic history?
A
- changes in bowel habits or malaise and vague, perhaps intermittent, crampy, abdominal pain in the epigastric or pertumbilical region
- pain subsequently migrates to the right lower quadrant over 12-24 h
- abdominal pain -> nausea, vomiting
- Anorexia
3
Q
Palpating in left lower quadrant causes pain in the right lower quadrant
A
Rovsing’s sign
4
Q
Internal rotation of the hip causes pain, suggesting the
possibility of an inflamed appendix located in the pelvis
A
Obturator sign
5
Q
Extending the right hip causes pain along posterolateral back and hip, suggesting retrocecal appendicitis
A
lliopsoas sign
6
Q
- sensitivity is 0.86, with a specificity of 0.81
- include wall thickening, an increased appendiceal diameter, and the presence of free fluid
A
Ultrasonography
7
Q
- Sensitivity 0.94 and specificity 0.95,
- dilatation >6 mm with wall thickening, a lumen that does not fill with enteric contrast, and fatty tissue stranding or air surrounding the appendix
A
CT Scan
8
Q
- inflammation of the visceral and parietal peritoneum,
- is most often but not always infectious in origin (secondary peritonitis)
- perforation of a hollow viscus.
A
Peritonitis
9
Q
when a specific intraabdominal source cannot be identified
A
Primary or spontaneous peritonitis
10
Q
- most commonly caused by the abnormal presence of physiologic fluids (gastric juice, bile, pancreatic enzymes, blood, or urine)
- effects of normally sterile foreign bodies (surgical sponges or instruments)
- complication of systemic diseases like lupus erythematosus, porphyria, and familial Mediterranean fever.
A
Aseptic peritonitis
11
Q
- cardinal signs and symptoms
+ acute, typically severe, abdominal pain with tenderness and fever - Diffuse, generalized peritonitis
+ diffuse abdominal tenderness with local guarding, rigidity - Bowel sounds are usually absent to hypoactive
- Tachycardia and signs of volume depletion with hypotension
- Laboratory test- leukocytosis, acidosis
- Radiographic studies- dilatation of the bowel and associated bowel wall edema
- Stable patients with ascites- paracentesis
A
Peritonitis