Appendicitis Flashcards

1
Q

def

A

acute inflammation & infection of the appendix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

aetiology

A
initiated by luminal obstruction by:
1 faecolith (a hard mass of faeces in the intestinal tract which can block the appendix
2 lymphoid hyperplasia
3 oedema
4 helminths
5 caecal carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

epi

A

very common emergency surgical diagnoses

7% lifetime risk in UK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

history

A

classic presentation
-initially diffuse abdominal pain, periumbilical & colicky
-pain becomes sharp & localised to RIF
-anorexia & nausea are common
alternative presentations
-pain in right flank (retrocaecal appendix)
-pain in RUQ (long appendix)
-pain in lower abdomen (pelvic appendix)

-urinary frequency/loose stools due to bladder/bowel irritation by inflamed appendix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

examination

A
  • pyrexia
  • facial flush
  • tachycardia
  • abdominal pain at McBurney’s point, rebound tenderness, guarding
  • Rosving’s sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is McBurney’s point

A

2/3 along a line from umbilic to RASIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is Rosving’s sign

A

pain in RIF elicited by applying pressure to LIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

pathogenesis

A

luminal obstruction causes proliferation of bowel flora & inflammation
swelling causes obstruction & thrombosis of arteries therefore the appendix becomes gangrenous & necrotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

investigations

A
a clinical diagnosis
1 bloods
-high WCC & CRP
-LFTs
-amylase (to exclude pancreatitis)
2 urine
-microscopy, culture & sensitivity
-pregnancy
3 imaging
-USS difficult to visualise appendix
-CT has good sensitivity & specificity
4 diagnostic laparoscopy
-for accurate diagnosis & treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

management

A

general
-IV fluids
-broad-spectrum antibiotics (with signs of sepsis)
surgery
-appendicectomy
post-op
-antibiotics (especially for gangrenous/perforated appendix)
appendiceal abscess
-drainage either percutaneously (through the skin) or intraoperatively
-may treat with antibiotics, parenteral fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

complications

A

inflammatory mass
appendix abscess
perforation & peritonitis

POST-OP
infection
abscess
ileus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

prognosis

A

appendicectomy is curative

if appendicitis left untreated it can be life-threatening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the most common bacteria in the appendix

A

bacteriodes fragilis

e. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the alvarodo (MANTRELS) score

A
score used to indicate likelihood of appendicitis
Migration of pain to RLQ 1
Anorexia 1
N+V 1
Tenderness in RLQ 2
Rebound tenderness 1
Elevated temp 1
Leukocytosis 1
Shift of WBC to left 1 (high number of young WBC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how is uncomplicated appendicitis treated

A

appendicectomy and cefoxitin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what IV antibiotic is used for complicated appendicitis

A

cefoxitin