apenddix Flashcards
blood supply to appendix?
how to locate appendix once cecum has been identified?
appendiceal artery
following teniae coli
pathophysiology with causes of appendicitis?
inflammation of appendix due to luminal obstruction by lymphoid tissue hyperplasia or fecalith or idiopathic -> inflammation -> ischemia and necrosis
signs and symptoms of acute appendicitis?
low grade fever, N/V, anorexia (LOSS OF APPETITE), periumbilical pain (crampy and intermittent) which is referred pain due to peritoneal irritation. it migrates then to the RLQ and becomes constant and severe.
more signs of peritoneal irritation: guarding and rebound tenderness.
obturator sign: pain upon internal rotation of the leg with knee and hip flexed.
psoas sign: pain upon hip extension with knee fully extended
rovsing sign: palpation of LLQ causes tenderness in RLQ
mcburney point: point of maximum tenderness which is 1/3 distance between ASIS and the umbilicus
DDx and mimics of acute appendicitis?
mesenteric adenitis by yersinia enterocolitica, meckel diverticulum, psoas abscess, gastroenteritis (pain follows vomiting, in AA its the opposite), ectopic pregnancy, ovarian torsion, UTI or urolithiasis
diagnosis? and treatment
CBC: leukocytosis with high neutrophils
pregnancy test, urinalysis to rule out DDx (may find mild hematuria and pyuria and it’s normal).
CT abdomen: distended appendix, wall thickening, fat stranding, complications (if present)
tx: NPO, IV fluids, analgesics, antiemetics, antibiotics, lap appendectomy
complications of acute appendicitis?
perforation (give IV fluid, urgent appendectomy, antibiotics), abscess (antibiotics, drain, surgery after few weeks), gangrene
