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Z Year3 Gastro Conditions > Appendicitis > Flashcards

Appendicitis Flashcards

1
Q

What is appendicitis?

A

acute inflammation of the vermiform appendix

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2
Q

What is the main cause of acute appendicitis?

A
  1. Obstruction of the lumen of the appendix
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3
Q

What are the main causes for the obstruction causing acute appendicitis?

A
  1. Faecolith (a hard mass of faecal matter),
  2. normal stool
  3. lymphoid hyperplasia are the main
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4
Q

What age is appendicitis most common in?

A

10-20 years

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5
Q

What are the symptoms of appendicitis?

A
  1. Acute central abdominal pain move to right lower quadrant
  2. Anorexia
  3. Nausea and vomiting
  4. Right lower quadrant tenderness
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6
Q

What are the more systemic symptoms of appendicitis?

A
  1. Low grade pyrexia
  2. Flushed face and a fetor
  3. Reduced bowel sounds
  4. Guarding and rebound or percussion tenderness in RIF
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7
Q

What score is used appendicitis?

A

High or intermittent risk score (AIR and AAS) – Alvarado to rule out

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8
Q

What signs are present in appendicitis?

A
  • Rovsings signs
  • Psoas sign
  • Cope sign
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9
Q

What are the possible differential diagnosis with appendicitis?

A
  1. Acute mesenteric adenitis
  2. Viral gastroenteritis
  3. Meckel’s diverticulitis
  4. Intussusception
  5. Crohn’s disease
  6. Peptic ulcer disease
  7. Right-sided ureteric stone
  8. Cholecystitis
  9. Urinary tract infection
  10. Primary peritonitis
  11. Pelvic inflammatory disease
  12. Ruptured Graafian follicle (mittelschmerz)
  13. Ectopic pregnancy
  14. Ovarian torsion
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10
Q

What are some of the first things you check for in appendicitis?

A
  1. Look for signs of perforation appendix: look for sepsis

2. High suspicion in pregnant women

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11
Q

What first investigations do you order for appendicitis?

A
  1. FBC
  2. CRP
  3. Abdominal US
  4. Contrast enhanced abdominal CT
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12
Q

What would the fbc show in appendicitis?

A

mild leukocytosis (10-18 x 109/L or 10,000 to 18,000/microlitre)

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13
Q

What would the CRP be like in appendicitis?

A

elevated

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14
Q

What would the abdominal US show in appendicitis?

A

aperistaltic or non-compressible structure with outer diameter >6 mm

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15
Q

What would the contrast enhanced abdominal CT show in appendicitis?

A
  1. abnormal appendix (diameter >6 mm) identified

2. or calcified appendicolith seen in association with peri-appendiceal inflammation

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16
Q

What other investigations would you consider with appendicitis?

A
  1. Urinanalysis
  2. Pregnancy test
  3. Group and save
  4. Abdominal MRI
17
Q

What is the first line treatment for uncomplicated appendicitis (fit for surgery)?

A
  1. supportive treatment:
    - nil by mouth
    - analgesia
    - obstetric support is preggers
  2. Plus: appendicectomy
18
Q

What is the first line treatment for someone with uncomplicated appendicitis: unfit/does not want surgery?

A
  1. First line: supportive treatment:
    - nil by mouth
    - analgesia
    - obstetric support is preggers
  2. Plus: antibiotics
19
Q

What is the first line treatment for someone with complicated appendicitis: with free perforation and/or acutely unwell?

A
  1. supportive treatment
    - Involve critical care and seek immediate surgical input for any patient with suspected perforated appendicitis and signs of shock or sepsis
    - analgesia
    - obstetric support if preggers
  2. Plus:
  3. Emergency appendicectomy
  4. Post-op antibiotics
20
Q

What is the first line treatment for complicated appendicitis: stable with abscess or phlegmon?

A 
1st line: supportive treatment 
-nil by mouth
-analgesia
-obstetrics if preggers
Plus:
1.	Laparoscopic appendicectomy 
2.	Post op antibiotics
21
Q

What is the second line treatment for complicated appendicitis: stable with abscess or phlegmon?

A
  1. antibiotics and percutaneous image guided drainage

2. Consider: interval appendicectomy

22
Q

What are the possible complications with appendicitis?

A
  1. Perforation
  2. Generalised peritonitis
  3. Appendicular mass
  4. Appendicular abscess
  5. Surgical wound infection
23
Q

What is the prognosis of appendicitis like?

A

Leave 1 day after surgery is uncomplicated

24
Q

What is Murphy’s triad?

A
  1. Abdo pain: umbilical to right iliac fossa
  2. N+V
  3. Low grade fever
25
Q

Can symptoms vary?

A

Sx may be different in different groups of pts

26
Q

What are symptoms like in a child?

A

vague pain + stop eating favourite food

27
Q

What are symptoms like in elderly?

A

no pain, just confusion

28
Q

What are symptoms like in pregnant?

A

N+V, local peritonitis

29
Q

What is Pain at Mcburney’s point?

A

1/3 way from ASIS to umbilicus

30
Q

What does percussion and rebound tenderness mean?

A

pain on percussion / removal of pressure

31
Q

What is Rovsing’s sign?

A

palpation of the left iliac fossa causes right iliac fossa pain

32
Q

What is the psoas sign?

A

extension of the right thigh, in the left lateral position, causes right iliac fossa pain

33
Q

What is the obturator sign?

A

internal rotation of the flexed right thigh causes pain

Z Year3 Gastro Conditions (48 decks)

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