APPENDICITIS

Question 1

describe the pain from appendecitis

Answer 1

Both visceral and somatic components.
Distention of the appendix is responsible for the initial vague abdominal pain (visceral) often experienced by the affected patient. The pain typically does not localize to the right lower quadrant until the tip becomes inflamed and irritates the adjacent parietal peritoneum
(somatic) or perforation occurs, resulting in localized peritonitis.

Question 2

DD for appendicitis in children

Answer 2

mesenteric adenitis (often seen after a recent viral illness), acute gastroenteritis, intussusception,
Meckel’s diverticulitis, inflammatory bowel disease,
and (in males) testicular torsion.
Nephrolithiasis and urinary tract infection may be manifested with right lower quadrant pain in
either gender.

Question 3

DD for appendicitis in women of childbearing age

Answer 3

ruptured ovarian cysts, mittelschmerz (midcycle pain occurring with ovulation), endometriosis, ovarian torsion, ectopic pregnancy, and pelvic inflammatory disease.

Question 4

DD for appendicitis in the elderly and neutropenic population?

Answer 4

elderly - diverticulitis and malignancy

neutropenic patient - typhlitis (neutropenic enterocolitis)

Question 5

atypical presentation for appendecitis

Answer 5

retroperitoneal appendix - more subacute manner, with flank or back pain
appendiceal tip in the pelvis - suprapubic pain suggestive of urinary tract infection
on occasion - symptoms of small bowel obstruction
who were found to be obstructed by multiple interloop abscesses

Question 6

Rovsing sign

Answer 6

right lower quadrant pain on palpation of the left lower quadrant

Question 7

obturator sign

Answer 7

right lower quadrant pain on internal rotation of the hip

Question 8

psoas sign

Answer 8

pain with extension of the ipsilateral hip

Question 9

percentage of appendicitis without leukocytosis

Answer 9

10%

Question 10

appendix thickness in appendicitis it typically more than

Answer 10

7 mm in diameter

Question 11

US sensitivity & specificity for appendecitis

Answer 11

sensitivity - 78% to 83%,

specificity - 83% to 93%.

Question 12

TREATMENT OF Uncomplicated APPENDICITIS

Answer 12

prompt appendectomy
fluid resuscitation
IV ABx - broad-spectrum (against gram-negative and
anaerobic organisms)

Question 13

Open appendectomy - incision types

Answer 13

oblique muscle-splitting incision (McArthur-McBurney)
transverse incision (Rockey- Davis)
conservative midline incision

Question 14

Open appendectomy - technique

Answer 14

The cecum is grasped by the taeniae and delivered into the wound, allowing visualization of the base of the appendix and delivery of the appendiceal tip.
The mesoappendix is divided, and the appendix is crushed just above the base, ligated with an absorbable ligature, and divided. The stump is then either cauterized or inverted by a purse-string or Z suture technique. Finally, the abdomen is thoroughly
irrigated and the wound closed in layers.

Question 15

laparoscopic appendectomy - important managment before the beginning of the operation

Answer 15

The bladder is emptied by a straight catheter or by having the patient void immediately before the procedure

Question 16

when cultures should be obtained during appendectomy?

Answer 16

recent exposure to a health care environment or to antibiotic therapy because these factors increase the
likelihood of encountering resistant bacteria

Question 17

when drains are placed in perforated appendectomy?

Answer 17

Drains are not routinely placed unless a discrete abscess cavity is present. If an abscess cavity is present, a single closed suction Jackson-Pratt drain is placed within its base and left for several days.