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Year 3 - Met3a > Acute Appendicitis > Flashcards

Acute Appendicitis Flashcards

1
Q

What is the most common surgical emergency

A
  • Acute appendicitis
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2
Q

Why does appendicitis rarely occur in under 2s

A
  • because the appendix is cone shaped with a large lumen
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3
Q

What is the pathogenesis for acute appendicitis

A
  • gut organisms invade appendix wall after lumen obstruction by lymphoid hyperplasia, faecolith or filarial worms
  • leads to oedema, ischaemic necrosis and perforation
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4
Q

What is the presentation of acute appendicitis

A
  • periumbilical pain that moves to the RIF
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5
Q

why does the pain change location in acute appendicitis

A
  • Early inflammation irritates the structure and walls of the appendix, so a colicky pain is felt periumbilically
  • As inflammation progresses and irritates the parietal peritoneum (esp on examination), pain settles at McBurney’s point (2/3 of the way along from the umbilicus to the right ASIS)
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6
Q

What are the associated signs with acute appendicitis

A
  • tachycardia
  • fever
  • peritonism with guarding or rebound tenderness or percussion tenderness in RIF
  • anorexia
  • vomiting - rare
  • Constipation usual - though diarrhoea may occur
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7
Q

What named signs are associated with acute appendicitis

A

Rovsing’s sign = pain > in RIF than LIF when the LIF is pressed

Psoas sign = pain on extending hip if retrocaecal appendix

Cope sign = pain on flexion and internal rotation of the right hip if appendix in close relation to obturator internus

pain on right during DRE - suggests an inflamed, low lying pelvic appendix

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8
Q

What are the differential diagnosis to appendicitis

A
  • Ectopic pregnancy (do a pregnancy test!!!)
  • UTI
  • mesenteric adenines
  • cystitis
  • cholecystitis
  • diverticulitis
  • salpingitis/PID
  • dysmenorrhoea
  • Crohn’s disease
  • perforated ulcer
  • food poisoning
  • Meckel’s diverticulum
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9
Q

What investigations do you do in appendicitis

A
  • Bloods - neutrophils and CRP are raised
  • US - but not always visualised
  • CT - has high diagnostic accuracy and useful if diagnosis is unclear
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10
Q

What does pregnancy feel like with appendicitis

A
  • occurs in 1/1000 pregnancies
  • mortality higher (especially from 20 weeks gestation)
  • perforation is more common and increases foetal mortality
  • pain is often less well localised - may be RUQ and signs of peritoneum less obvious
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11
Q

What is the treatment of appendicitis

A

Appendicetomy

- open or laparoscopy

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12
Q

What antibiotics are you on appendicitis

A
  • Piperacillin/Tazobactam 4.5g/8h, 1-3 doses IV starting 1h pre-op – reduces wound infections
  • Give longer course if perforated
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13
Q

when is a laparoscopy not recommended

A
  • in cases of suspected gangrenous perforation as the rate of abscess formation may be higher
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14
Q

What are the complications of appendicitis

A
  • perforation
  • appendix mass
  • appendix abscess
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15
Q

describe who appendix perforation usually present in

A

more common of faecolith is present and in young children as the diagnosis is more often delayed

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16
Q

What does an appendix mass result

A
  • When inflamed appendix becomes covered with momentum
17
Q

How do you treat an appendix mass

A
  • Early surgery or initial conservative management - NBM and antibiotics
  • if the mass resolves some perform an interval (e.g. delayed) appendectomy
  • exclude colonic tumour that can present as early as 40 years
18
Q

When does an appendix abscess happen

A
  • may result if an appendix mass fail to resolve but enlarges and the patient gets more unwell
19
Q

What is the treatment of an appendix abscess

A
  • usually involves drainage (surgical or percutaneous under US/CT guidance) although antibiotics alone may bring resolution
20
Q

What are the different positions that the appendix can be in

A
  • retro-caecal
  • post-ileal
  • pre-ileal
  • pelvic
21
Q

Where is McBurney’s point

A

2/3 of the way along from the umbilicus to the right ASIS

22
Q

when does RUQ pain present with appendicitis

A

Inflammation in a retrocaecal/retroperitoneal appendix (2.5%) may cause flank or RUQ pain; its only sign may be ↑tenderness on the right on DRE

23
Q

How does perforated appendicitis present

A

Peritonitis

  • pain is in entire abdomen
  • constant and severe
  • fever is high
  • breathing and heart rate may be fast in response to severe pain
  • have other symptoms including chills, weakness and confusion
24
Q

what is the urine results in appendicitis

A
  • pregnancy test - rule out ectopic pregnancy

- done to rule out UTI

Year 3 - Met3a (43 decks)

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