Acute Appendicitis

Question 1

Definition of Acute Appendicitis

Answer 1

Purulent process in the gut

Question 2

Gold standard for diagnosis

Answer 2

US

Question 3

3 Stages of Acute Appendicitis

Answer 3

1. Acute Catarrhal appendicitis - inflammation of mucus layer inside the appendix
2. Acute Phlegmonous appendicitis - inflammatory process w/0 boundaries (all layers are involved)
3. Acute Gangrenous appendicitis - necrosis spotting

Question 4

How long does it take for acute catarrhal appendicitis to turn into acute phlegmonous?

Answer 4

6-10 hours

Question 5

Duration of acute gangrenous appendicitis

Answer 5

About 24 hours and more (very serious)

Question 6

2 main syndromes of Acute Appendicitis

Answer 6

1. Abdominal Syndrome with peritoneal signs
2. Intoxication Syndrome

Question 7

Clinical Picture of Abdominal Syndrome with peritoneal signs (Acute Appendicitis)

Answer 7

• Pain starts usually everywhere/upper stomach -> shifts to right lower quadrant
• Character of pain: involvement of peritonitis -> muscle guarding (+), Rebound tenderness (+)

Question 8

Clinical Picture of Intoxication Syndrome (Acute Appendicitis)

Answer 8

1. Fatigue
2. Fever
3. Tachycardia
4. Hypotension
5. Chills
6. Pale skin

Question 9

5 complications of Acute Appendicitis

Answer 9

1. Appendicular infiltrate: divided into two: a. Resolution (DO NOT THINK!) b. Abscess (usually).
2. Intrabdominal abscess: grows bigger -> rupture -> pus in the abdomen.
3. Retroperitoneal abscess
4. Diffuse peritonitis
5. Pylephlebitis: purulent thrombophlebitis of portal vein (fatal/dangerous)

Question 10

Pylephlebitis Complication

Answer 10

Liver damage
*Explanation: Thrombus/Emboli with microorganism travels to liver, infection spreads inside the liver ( a lot of small emboli) -> Increase abscess formation -> very difficult to treat -> sepsis.

Question 11

Patients with these issues are difficult to diagnose with acute appendicitis.

Answer 11

1. Children: difficult to communicate with
2. Pregnant women: dislocation of appendix
3. Elderly: are insensitive and there are no signs of peritonitis (check well!)
4. Different locations of Appendix.

Question 12

What are the different locations of appendix?

Answer 12

1. Pelvic:
   - Appear in pelvis
   - Pain radiation is usually in same (normal) location
   - Appendix is covered with other organs
   - Exclude food poisoning: pts go to toilet often, unproductive events -> no stool; fever, chills, abdominal discomfort w/o signs of appendicitis.
   - Physical examination
2. Sub-hepatic
3. Hepatic (gets worse)
4. Retroperitoneal:
   - Exclude kidney disease (pyelonephritis)
5. Retrocecal
6. Left sided appendicitis:
   - Exclude sigmoiditis, pyelonephritis, diverticulitis & possibly adenocarcinoma of ileus (left level of ileus large intestine)
   - Can be due to Right-sided heart (Kartagener Syndrome)
7. Post-ileal
8. Pre-ileal
9. Subcecal