Appendicitis Flashcards

1
Q

Examining an abdomen - what to do before you even touch patient?

A
  • Get them to fully blow tummy out
  • Then fully suck in
  • Then cough
  • Will see patients with peritonism doing very little movements and even localise their pain by putting a hand do it
  • Then you can examine away from these areas first
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2
Q

Pathophys of appendicitis

A
  • Luminal obstruction
  • Faecolith or lymphoid hyperplasia (rarer malignancy can cause)
  • Inflammation then occurs as bacteria multiply
  • Increased pressure, reduced venous drainage –> ischaemia
  • –> necrosis and can perforate
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3
Q

RF appendicitis

A
  • FH
  • Ethnicity - caucasions
  • Environmental - summer
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4
Q

Presentation of appecidicitis

A
  • Abdominal pain
  • Poorly localised, dull peri-umbilical pain
  • Later migrates to RIF
  • Can have vomitting, anorexia, nausea or diarrhoea too
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5
Q

Examination appendicitis

A
  • Rebound tenderness
  • Percussion tenderness over McBurneys point
  • Guarding esp if perforated
  • In severe cases, signs of sepsis
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6
Q

Specific examination signs for appendicitis

A
  • Rovsings sign - palpation of LIF causes pain in RIF
  • Psoas sign - RIF pain on extension of R hip - retrocaecal appendix abutting psoas muscle
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7
Q

What is McBurneys point?

A

2/3 the way from umbilicus to ASIS

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8
Q

Appendicitis in children vs adults

A
  • Childen can present atypical
  • Can just be diarrhoea, urinary symptoms and left sided pain sometimes
  • Always examine all systems and check genitals to exclude torsion
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9
Q

Differentials for appendicitis

A
  • Ovarian cyst rupture, ovarian torsion, ectopic pregnancy, PID
  • IBD, Meckels diveriticulum, diverticular disease
  • Testicular torsion, epididymo-orchitis
  • Ureteric stone, UTI, pyelonephritis

Based on anatomy in that area

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10
Q

Investigations for suspected appendicitis

A
  • Urinalysis - assess for renal/urological cause
  • Pregnancy test for women of reporductive age
  • Routine bloods - FBC, CRP, Clotting screen, group&save, serum b-hCG if not excluded ectopic

Can get +ve leukocytes on urine dip due to local inflammation

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11
Q

Imaging for appendicitis

A

Clinical assessment with biochemical picture can diagnose
But due to wide differentials may need:
* USS - gynae and children
* CT - appendicitis, assess GI and urological
* MRI - 2nd line in children and women

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12
Q

Risk stratification scores appendicitis

A
  • Men - appendicitis inflammatory response score
  • Women - adult appendicitis score
  • Children - Shera score

These are best for each group

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13
Q

Management appendicitis

A
  • Laparascopic appendicectomy
  • Certain cases can be trialled with abx alone if high risk surgery with uncomplicated
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14
Q

How management differs with appendiceal mass

A
  • If mass, abx therapy
  • Interval appendicetomy performed 6-8 weeks later
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15
Q

What is an appendiceal mass?

A
  • Inflammatory phelgmon (acute inflam of soft tissues)
  • Formed by body in response to acute appendicitis
  • Oedematous and adherant omentum and small bowel loops form around appendix (almost becomes a sticky ball of inflammation)
  • Can be diagnosed pre-op via exam and imaging
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16
Q

What happens to appendix once removed?

A

Sent to histopathology to assess for underlying malignancy

17
Q

Complications of acute appendicitis

A
  • Perforation
  • Surgical site infection
  • Appendiceal mass
  • Abscess formation - delayed presentation, need IV abx and radiologically guided drainage prior to surgery
18
Q
A