Appendicite

Question 1

What is the anatomy of the appendix?

Answer 1

All the same layers (histologic) as the rest of the colon at the junction of the small intestine and large intestine

Nodules lymphoïdes paroi —> adolescence

Question 2

Where can the appendix be positioned?

Answer 2

Fosse iliaque droite, sous-caecale, pré-iléale, post-iléale, rétrocaecale, pelvienne

Question 3

What is the pathophysiology of appendicitis?

Answer 3

Obstruction de la lumière: fécalith, nodules lymphoides

Augmentation de la pression luminale: obstruction lymphatique, compression veineuse, nécrose de la muquese —> infection, nécrose transmurale —> rupture, abcès

Question 4

What are the sx of appendicitis?

Answer 4

malaise, general peri-umbilical pain

4-12 hours later

Anorexia, lack of appetite, vomiting, low-grade fever (38C)

12-24 hours later

Migration of pain to the fosse iliaque droite (point de McBurney)

Question 5

E/P d’un patient avec appendicite:

Answer 5

Dim. of peristalsis, iléus paralytique (hypomotricité intestinale d’origine fonctionnelle), hyperesthésie cutanée à FID, signe de Rovsing (pression FIG

• —> douleur FID), signe de psoas (retrocecal), signe de l’obturateur (pelvien), douleur au toucher rectal/marche/touch

ACCALMIE TRAÎTRESSE: nécrose ou rupture

Question 6

What are the lab reports for someone with appendicitis?

Answer 6

FSC: lymphocytosis 12k-18k (n<11.5k)

Sommaire et microscopie des urines: sang: calcul urétéral, lymphocytes: infection urinaure

Get B-HCG —> pregnancy test

Question 7

What are some other dx tests?

Answer 7

Radiographie simple: fécalithe, iléus paralytique (anse sentinelle), pas d’air libre

Échographie abdominale: appendice de 7mm er plus non-compressible, fécalithe, collection liquide autour de l’appendice

Tomodensitométrie: épaississement de la paroi de l’appendice, appendice distendu (plus de 6mm), appendice sans contraste luminal

Question 8

How is appendicitis treated?

Answer 8

Antibiotiques: only —> 35% de récidive

Appendectomie: ouverte ou laparoscopique

Question 9

What are some complications of appendectomies? (5%)

Answer 9

perforation (10-30%), peritonitis, septic shock, septic portal phylephlebitis, hepatic abcesses, peri-appendicular abcesses

0.08% mortality rate

Question 10

What happens when you get appendicitis during pregnancy?

Answer 10

Presentation masked by pregnancy

Appendix is raised by the uterus

Better to do an echo to check

Question 11

What are the risks of “appendicectomie tardive perforée”?

Answer 11

Risk of spontaneous abortion, mortality risks increased