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#passmed 2023 > Appendicitis > Flashcards

Appendicitis Flashcards

1
Q

What is Appendicitis?

A

Inflamm of appendix

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2
Q

What ages does Appendicitis most commonly happen at?

A

10-20 yrs

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3
Q

What is the pathophysiology of Appendicitis? (5 steps)

A
  1. Lumen obstruction by Lymphoid Hyperplasia / Faecolith / Filarial Worm
  2. Pathogens get trapped bc obst @ point where appendix meets bowels
  3. Pathogens –> infection + inflamm
  4. Inflamm –> gangrene –> Appendix ruptures
  5. Faecal contents + infective material released into –> Peritoneal Cavity
  6. Peritonitis (inflamm of peritoneal lining)
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4
Q

What is a Faecolith?

A

Stony mass of compacted faeces

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5
Q

What are the CF of Appendicitis? (5 + 7 things)

A
  1. Periumbilical pain –> moves to RIF (within first 24 hrs)
  2. Fever (low grade)
  3. LOA (loss of appetite)
  4. N + V
  5. Conspitation (sometimes diarrhoea)

@ exam

  1. Rovsing’s Sign
  2. Psoas Sign
  3. Cope Sign
  4. Guarding
  5. Tenderness @ McBurney’s Point
  6. Rebound tenderness (perforation)
  7. Percussion tenderness (perforation)
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6
Q

What is the explanation for the shift of Periumbilical to RIF pain as Appendicitis progresses? (2 things)

A
  1. Early inflamm = irritiates structures + walls of appendix –> colicky pain referred to Periumbilical region
  2. Inflamm progresses = irritates parietal peritoneum (esp @ exam) –> somatic + lateralized pain @ McBurney’s Point in RIF
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7
Q

Where is McBurney’s Point?

A

1/3 of distance between Anterior Superior Iliac Spine (ASIS) and Umbilicus

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8
Q

What is Rovsing’s Sign? (2 things)

A
  1. Press the LIF (only)
  2. More pain in RIF than LIF
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9
Q

What is Psoas Sign?

A

Pain @ hip extension (if retrocaecal appendix)

Retrocaecal appendix = appendix inflammed so much it’s risen up to be behind level of caecum

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10
Q

What is Cope Sign? (2 things)

A
  1. Pain @ flexion + int rot of R hip
  2. Indicates inflamm pelvis is close contact w obturator internus muscle
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11
Q

What is the diagnosis of Appendicitis usually based on? (2 things)

A
  1. Clinical features
  2. Raised inflamm markers

(But imaging used in uncertain cases)

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12
Q

What investigations should you do for sus Appendicitis?

A
  1. Bloods
  2. CT (highest diagnostic accuracy)
  3. US (females / kids)
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13
Q

What may the bloods of a Appendicitis show? (2 things)

A
  1. Neutrophil lecuocytosis (high no. of neut)
  2. Elevated CRP
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14
Q

What is the use of a CT in sus Appendicitis? (2 things)

A
  1. Highest diagnostic accuracy (used to confirm diagnosis)
  2. Reduces -ve appendicectomy rate
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15
Q

Why would you do US on sus Appendicectomy on females?

A

To exclude ovarian + gynaecological pathology

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16
Q

Why would you do US on sus Appendicectomy on kids?

A

Less radiation than CT

17
Q

What should you do when CF suggest Appendicitis, but investigations are negative?

A

Diagnostic Laparoscopy to visualise appendix directly

Can do appendicectomy str8 away if indicated

18
Q

What are some DD of Appendicitis? (4 things)

A
  1. Ectopic pregnancy
  2. Ovarian cysts
  3. Meckel’s Diverticulum
  4. Mesenteric Adenitis
19
Q

Which sus Appendicitis patients should you consider the DD of Ectopic Pregnancy for?

Why is this important?

A

Females of child-bearing age

Ectopic pregnancy = gynaecological EMERGENCY w high mortality if mismanaged

20
Q

How do you differentiate between Appendicitis and Ectopic Pregnancy?

A

Serum / urine Human Chorionic Gonadotropin (hCG)

21
Q

How do Ovarian Cysts present similary to Appendicitis?

A

Pelvic / iliac fossa pain

(Esp when rupture / torsion)

22
Q

What is Mesenteric Adenitis?

A

Inflamed abdominal lymph nodes

23
Q

How does Mesenteric Adenitis present similarly to Appendicitis?

A

Abdominal pain, in young children

24
Q

How can you differentiate Mesenteric Adenitis from Appendicitis?

A

MA = often assoc w tonsillitis / URTI

25
Q

What is the initial management of a patient w sus Appendicitis? (2 things)

A
  1. Emergency admission for appendicectomy surgery
  2. Abx
26
Q

What is the definitive treatment for Appendicitis?

A

Appendicectomy (usually laparoscopic)

27
Q

When is the Appendicectomy preffered to do LAPAROSCOPICALLY? (2 things)

A
  1. Women
  2. Obese
28
Q

When is the Appendicectomy preferred to NOT do it laparoscopically?

Why?

A

Sus gangrenous perforation

Bc higher rate of abscess formation

29
Q

What are the complications of an Appendicectomy? (6 things)

A
  1. Removal of normal appendix
  2. Damage to bowel / other organs
  3. Bleeding
  4. Infection
  5. Pain + Scars
  6. DVT / PE
30
Q

What are the complications of Appendicitis? (3 things)

A
  1. Perforation (13-20% of cases)
  2. Appendix Mass
  3. Appendix Abscess
31
Q

When is Perforation more commonly seen as a complication of Appendicitis?

Why?

A
  1. When Faecolith present
  2. Young children

Bc diagnosis often delayed

32
Q

How can Appendix Masses occur as a complication of Appendicitis?

A

When Appendix becomes covered with omentum

33
Q

How is an Appendix Mass (complication of Appendicitis) diagnosed?

A

US / CT

34
Q

How should you manage an Appendix Mass (complication of appendicitis)? (3 points)

A
  1. Early surgery

OR

  1. Conservatively: NBM / Abx
  2. If resolved, can do delayed Appendicectomy
35
Q

What should you exclude when you sus Appendix Mass (complication of Appendicitis)?

How will you exclude it?

A

Colonic tumour (presents early as 40 yrs old)

Laparotomy or Colonoscopy

36
Q

How can an Appendix Abscess occur as a complication of Appendicitis? (2 points)

A
  1. Appendix Mass fails to resolve –> enlarges
  2. Patient becomes more unwell
37
Q

What is the treatment for an Appendix Abscess (complication of Appendicitis)? (2 things)

A
  1. Drainage (surgical / percutaenous under CT/US guidance)
  2. Abx (could resolve it alone)

#passmed 2023 (39 decks)

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