Appendicitis And Diverticulitis Flashcards
What is appendicitis?
Inflammation of the appendix
What must be done once appendicitis is discovered?
Surgical removal
What is the function of the appendix?
Has no function its a vestigial structure
What are the potential causes of the inflammation of the appendix (appendicitis)?
Obstruction:
Fecalith (hardened piece of stool stuck in appendix)
Lymphoid hyperplasia near appendix
Foreign bodies (rare)
What it’s the danger of apppendicitis?
Pressure in appendix increases due to blockage + inflammation
Venous congestion occurs causing oedema and impaired blood flow to the appendix causing necrosis of apppendix
Necrotic appendix can rupture/perforate releasing contents into peritoneum leading to infection of peritoneum called PERITONITIS
What are the symptoms of appendicitis?
Initially rough pain around umbilicus
Pain then localises to right lower quadrant in the RIGHT ILIAC FOSSA
At what point does the pain in appendicitis shift from diffuse pain around the umbilicus too specific pain in the right iliac fossa and why?
When the inflamed appendix comes into contact with the parietal peritoneum
Parietal peritoneum has a very well defined nerve supply so the pain is more intense and localised to that area
How is appendicitis diagnosed?
Rebound tenderness in RLQ (inc pain when pressure released from area)
Slightly ill
Slight fever/tachycardia
Imaging like Ultrasound or CT
How is appendicitis treated?
Appendectomy
Removal of appendix through either open surgery or laparoscopy
Why must appendicitis be treated quickly?
Prevent it perforating and causing peritonitis
What is Diverticulosis?
Presence of small, pouch like outpouchings called diverticula in the colon especially in the sigmoid colon
What leads to the formation of diverticula (outpouchings of large colon) in diverticulosis?
Inc pressure in colon:
-low fibre diet
-age related weakening of colon wall
How does diverticulosis present?
Asymptomatic
Usually discovered during diagnostic procedures like colonoscopy or imaging scans
What is diverticular disease?
Abdominal pain and discomfort of individuals with diverticulosis
Pain is normally mild and happens without signs of inflammation or infection
What is acute diverticulitis?
When one or ore diverticula become inflamed or infected
What are the symptoms of acute diverticulitis?
LLQ pain
Fever
Bloating
Constipation
Rectal bleeding
What is the term for rectal bleeding??
Haematochezia
What are some complications of the inflammation of the diverticula in acute diverticulitis?
Abscesses
Fistulas (abnormal connections between organs)
Perforation of diverticula
How is acute diverticulitis diagnosed?
Clinical evaluation
Blood tests (inc white cells)
Ultrasound, CT
How is acute diverticulitis treated?
Antibiotics
Analgesia
Diet modification t clear source of infection and prevent recurrence
What is the potential treatment for complicated diverticulitis?
If large abscesses or perforation surgical removal may be needed
Partial colectomy
Why do diverticula typically form in the sigmoid colon?
Has the highest pressure here due to peristalsis and firm stool consistency
Why can acute appendicitis present differently?
Location of appendix can vary
What locations cant eh appendix be in?
(Look at slide 3 of the appendicitis lecture)
Retro-caecal
Pelvic
Sub-caecal
Para-ileal
What are the 3 categories of appendicitis?
Acute (mucosal oedema)
Gangrenous (transmural inflammation and necrosis)
Perforated
Why can appendicitis present different in pregnant women?
Anatomy is different
What is McBurneys Point?
Point 2/3s from umbilicus to ASIS where pain is experienced in the right iliac fossa with appendicitis
What actually are the outpouchings in diverticulosis?
Mucous and submucosa herniating through the Muscularis layers of teh large intestine
Happens where nutrient vessels (vasa recta) penetrate bowel wall
