Appendicitis

Question 1

Appendix

Answer 1

Finger-like appendage (10cm), just below ileocecal valve.
Fills with food and empties into cecum.
Prone to obstruction and infections.

Question 2

Appendicitis

Answer 2

leading digestive disease resulting in hospitalization in Canada - surgery is necessary.
Most common age 10-30

Question 3

Appendicitis Patho

Answer 3

becomes inflamed and edematous from kinking or occlusion by hard mass of stool, tumour or foreign body-inflammation.
eventually inflamed appendix fills with pus.

Question 4

Appendicitis complication

Answer 4

perforation of the appendix - can lead to peritonitis, abscess formation or portal pylephlebitis (inflamed thrombus in portal vein).
generally occurs within 24 hrs after onset of pain - will have a fever, toxic appearance.

Question 5

Appendicitis Clinical Manifestations

Answer 5

vague epigastric or periumbilical pain progressing to right lower quadrant.
usually accompanied by low grade fever, N/V, constipation (laxatives should not be given as they can result in perforation).
local tenderness at McBurney’s point in up to 50% of cases when pressure applied.
Rebound tenderness - worsening of pain when pressure released.

Question 6

Psoas sign

Answer 6

pain is elicited in the RLQ when the patient raises their leg against resistance.

Question 7

Obturator sign

Answer 7

pain elicited in RLQ when patient lies supine and right leg is lifted and rotated internally.

Question 8

Rosving sign

Answer 8

is felt in RLQ when deep palpitation is applied to the LLQ - pain worsens when pressure is removed.

Question 9

Assessment + Diagnostic findings

Answer 9

elevated WBC neutrophils.
pregnancy test to rule out ectopic pregnancy.
X-ray, ultrasound or CT might reveal right lower quadrant density or localized distention of bowel.
diagnostic laparoscopy.

Question 10

Emergency Management of Appendicitis

Answer 10

patient NPO.
IV hydration with isotonic solution.
pain management - e.g. morphine
prepare for surgery - consent, peri-operative teaching.
admin prophylactic antibiotics.

Question 11

Appendectomy Post-op

Answer 11

position in high fowlers to reduce tension on incision.
manage pain with opiates.
fluids + food as tolerated when bowel sounds return on day of surgery.
if peritonitis possible - drain left in place, hospitalized for several days, discharge includes home care teachings.