Acute Appendicitis Flashcards
Definition
anatomical position of the appendix normal size of appendix
Acute appendicitis is a bacterial inflammation of the appendicitis
The appendix is usually located in the lower right quadrant of the abdomen
Connected to the cecum of the large intestine
Normal size of appendix- 6-10cm
Positions of appendix
1 Retrocecal appendix: The appendix is located behind the cecum, which is the first part of the large intestine. This is the most common position of the appendix.
2 Paracecal appendix: The appendix is located beside the cecum.
3 Subcecal appendix: The appendix is located below the cecum.
4 Preileal appendix: The appendix is located in front of the ileum, which is the last part of the small intestine.
5 Postileal appendix: The appendix is located behind the ileum.
Etiology of acute appendicitis
Infection: Bacterial or viral infections
• Genetic factors
• Age: 10 and 30.
• Diet: A low-fiber diet
• Environmental factors:, such as air pollution or certain occupational exposures,
• Immune system dysfunction
Tumors
Gallstones
Foreign body
Fecalith A fecalith is a hard, stone-like mass that can form in the appendix and contribute to the development of acute appendicitis. Fecaliths are composed of fecal matter, calcium, and other substances that can build up and harden over time.
Forms of acute appendicitis
Acute simple
Acute phlegmous -leukocyte infiltration
Acute gangrene- necrosis occurs
Catarrh -inflammation in mucus membrane
Perforated
In a.a WBC is greater than 10,000
Normal WBC 40,000 - 10,000
Forms of A.A on examination
Acute simple - tensed appendix serous membrane hyperemic (reds and edematous
Phlegmonous- thickened appendix tense hyperemic pus in appendicular cavity
Exudate in abdominal cavity or ascites in abdominal cavity (accumulation of fluid)
Ascites is thin watery appears cloudy or opaque
Gangrenous-necrosis of appendix wall
Thrombosis of appendix vessels (blood clot in vessels)
Symptoms of A.A
Pain -constant and in right iliac fossa and increases during palpation
Vomiting provoked by pain
High temperatures in axillary which is the armpit region-36
And digital is above 38
Tachycardia
Dry mouth dry tongue
Signs of A.A
Koshers sign - pain radiating from epigastric region to right lilac fossa
Rovsing sign - pain is felt in the left iliac fossa when doctor palpate right iliac fossa ( due to shift of bowel loops)
Blumberg sign-abdominal tenderness
Patient is asked to cough doctor watches facial expressions,coughing produces pain
Rebound tenderness (razdolsky)
On percussion/-gently pressing into the right lower quadrant of abdomen and hand is released suddenly see discomfort on patient’s face
Psoas test- specific for retrocecal A
Hyperextension of hip causes pain in right ilac fossa
Obturator test for pelvic A
Internal rotation of right hip
Investigations clinical diagnosis
Urine analysis
Blood tests -leuckocytes (often to levels between 10,000 and 20,000 μL
Chest X-ray reveal chest X-ray may appear normal, as the appendix is not located in the chest and the inflammation localized to the abdomen.Atelectasis: In some cases, patients with acute appendicitis may develop atelectasis, which is a collapse of part of the lung. This can occur due to shallow breathing or decreased mobility associated with abdominal pain.Pleural effusion:, patients with acute appendicitis may develop a pleural effusion, which is a buildup of fluid in the space between the lung and the chest wall.
Abdominal X-ray -
Fecalith: In some cases, a fecalith (a hardened piece of stool) may be visible on X-ray within the appendix.
• Free air: If the appendix has perforated, free air may be visible on X-ray within the abdominal cavity.
• Dilated bowel loops: In some cases, the bowel loops in the right lower quadrant may appear dilated on X-ray due to inflammation and obstruction of the appendix.
Compulsory imaging
Ultrasound • Enlarged appendix: The appendix may appear enlarged and thickened on ultrasound, with a diameter greater than 6mm.
• Hyperemia: Increased blood flow to the appendix may be visible on color Doppler ultrasound.
• Fecalith: A fecalith may be visible within the appendix on ultrasound.
• Free fluid: In some cases, free fluid may be visible within the abdominal cavity, which can be a sign of inflammation or perforation.
Ct scan also
Complications of A.A
Appendicular infiltrate
Periappendiceal abscess
Peritonitis
Pylephlebitis spreading of infection affecting the portal system and liver resulting in liver abscess phlebitis
Surgery
Prepare for surgery -shave empty bladder premedication gastric lavage
Anaesthesia during appendectomy
Intravenous A or endotracheal A ( pregnant woman,children,peritonitis,weight gain )
Local A
Surgical treatment
Open appendectomy
Laparoscopy A
Open Appendectomy (Conventional) - Incision
• The incision is placed at the point of maximum
tenderness.
• APPROACHES;
1. Mc Burney’s/Grid iron; an incision
placed perpendicular to the McBurney’s
point i.e an lateral 1
9 and medial 2/3 of an
imaginary line joining
he ASIS and the
umbilicus.
2. Lanz; skin crease incision.
Cosmetically better. approximately 2 cm
below the umbilicus centered on the mid-
clavicular- mi inguinal line.
3. Rutherford Morison’s ; muscle
cutting. The muscles are cut upwards
and laterally- cutting the internal
oblique and transverses abdominis-
extension of Mc Burney
4. Right Paramedian;
Laparoscopy is a surgical procedure that is sometimes used to diagnose and treat acute appendicitis. It involves the use of a small camera and specialized surgical instruments to view the abdominal cavity and remove the appendix.
During a laparoscopic appendectomy, the surgeon makes small incisions in the abdomen and inserts a laparoscope (a thin, flexible tube with a camera at the end) to view the internal organs. If acute appendicitis is confirmed, the surgeon can then use specialized instruments to remove the appendix through the small incisions.
Laparoscopic appendectomy is typically used in cases where the diagnosis of acute appendicitis is unclear or in patients who have undergone previous abdominal surgeries, as it allows for a direct visualization of the appendix and surrounding structures. It is considered a less invasive alternative to traditional open appendectomy, as it typically results in shorter hospital stays, quicker recovery, and less post-operative pain.
Acute abdomen
A condition when the patient has acute pain in abdomen for more than 6hours
Appendicular infiltration definition
Specific form of inflammation which is characterised by adhesive process which join large intestines and small intestines joined by large mass of infiltrate
there is an accumulation of pus or inflammatory cells in the tissues surrounding the appendix. It occurs when the inflammation of the appendix spreads beyond its walls and affects adjacent tissues and organs.
Clinical diagnosis and what doctor dress appendicular infiltration
Pain is not strong
Unstable stool
no temperature
there’s a mass like tumor in the right iliac fossa
Patient is hospitalised
Antibiotic therapy if mass doesn’t dissolve operation is performed (appendectomy)
Two
Infiltrate disappears and patients recovers
Infiltrate transforms to abscess that’s when doctor does incision and drainage
Peritonitis
Can be serous or transudent
Acute pancreatitis, perforated ulcer, acute cholecytsis, strangulated hernia are peritonitis
Diffused p - when p covers 3,4,5 areas like the right ilac, pelvic,right hyperchondrum
Symptoms
Stages of p
Treatment
Pain
Guarding
Tenderness
Rigidity
Blimberg sign
On percussion pain increases during moment sneezing coughing breathing
No sound during auscultation
Stool and gas retention
Tachycardia dry mouth dry tongue
Decrease urine (oliguria,anuria)
Dull sound during percussion
Stages
First-reactive phase/shock period
Second -toxic phase
Dry mouth tachycardia diuresis decrease intoxication increase
Third-characterized by exhaustion of NS .impaired renal function liver impairment
Forth-sanitation remove of all exudates and drainage
Surgery - operation ,sanitation remove exudates . Can be colonoscopy,laparoscopy,appendectomy
Treatment drug first antibiotics-vancomycin metopenenem ciprofloxcin
Detoxification method
Plasma transfusion
Dialysis
Transfusion of electrolytes leucocytes thrombocytes
