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

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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
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3
Q

Palpating in left lower quadrant causes pain in the right lower quadrant

A

Rovsing’s sign

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4
Q

Internal rotation of the hip causes pain, suggesting the

possibility of an inflamed appendix located in the pelvis

A

Obturator sign

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5
Q

Extending the right hip causes pain along posterolateral back and hip, suggesting retrocecal appendicitis

A

lliopsoas sign

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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

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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

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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

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9
Q

when a specific intraabdominal source cannot be identified

A

Primary or spontaneous peritonitis

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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

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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

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