Appendicitis + Diverticulitis Flashcards
What is the appendix?
Diverticulum off the caecum
Has complete longitudinal layer of muscle
Blood supply of the appendix
Appendicular artery
Through the mesoappendix from the ileocolic branch of SMA
What are the possible locations of the appendix?
Retro-caecal
Pelvic
Sub-caecal
Para-ileal (pre or post)
What is the primary cause of appendicitis?
-
Blockage in appendix which creates higher pressure
e.g. faecolith, lymphoid hyperplasia, foreign body - this causes an increased venous pressure > oedema in walls of appendix > limited arterial blood supply > ischaemia of appendix walls > bacterial infection + inflammation
What is faecolith?
Hardened stool
What can a rupture appendix cause?
Peritonitis
What is a cause of appendicitis other than a blockage?
Viral or bacterial infection
caused by mucosal changes that allow invasion of appendiceal walls
Symptoms of appendicitis
- poorly localised peri-umbilical pain
- anorexia (loss of appetite)
- nausea + vomiting
- constipation
- low grade fever
- after 12-24 hours pain is felt more intensity in right iliac fossa
What position of the appendix may you not get right iliac fossa pain in appendicitis?
Where is pain felt instead?
rectro-caecal or pelvic
-parietal peritoneum in RIF doesn’t come into contact with inflamed appendix
- supra-pubic pain, right sided rectal or vaginal
Pain in appendicitis if appendix if in retro-caecal or pelvic position
Supra pubic pain
Right sided rectal
Or vaginal pain
Signs of appendicitis
Patients appear slightly ill
- slight fever
- tachycardia
- localised right quadrant tenderness
- rebound tenderness in right iliac fossa
- patient lies still
- rovsing’s sign
Diagnosis of appendicitis
- raised WBC in FBC
- history/physical exam (especially rebound tenderness)
- pregnancy test/urine dip to rule out pregnancy or UTI
Treatment of appendicitis
Open appendectomy
Laprascopic appendectomy
What is McBurney’s point?
2/3 of way from umbilicus to ASIS
Where appendix classically lies
Where does the appendix classicaly lie?
McBurney’s point
Symptoms of diverticulosis
Asymptomatic
Where does diverticulosis occur?
In colon (85% in sigmoid colon)
Where nutrient vessels (vasa recta) penetrate the bowel wall
Cause of diverticulosis
Increased intra-luminal pressure
(Low fibre diet)
What is diverticular disease?
Patient experiences symptoms/pain but no inflammation/infection
What is acute diverticulitis
When the diverticula become inflammatory or perforate (+/- bleeding and abscess formation)
Symptoms of diverticulitis
- lower left iliac fossa pain
- fever
- bloating
- constipation
- haematochezia
Signs of acute diverticulitis
- localised abdominal tenderness
- distension
- reduced bowel sounds
- signs of peritonitis if perforation
Diagnosis of acute diverticulitis
- blood test: raised WBC
- pregnancy test to exclude ecoptic pregnancy
- ultra sound
- CT
- colonoscopy if large haematochezia
- elective colonoscopy to determine cause of symptoms
Treatment of acute diverticulitis
- antibitoics
- fluid resuscitation
- analgesia
- surgery if perforation or large abscess needs to be drained
What is haematochezia?
Bright blood in stool
Cause of acute diverticulitis
- entrance to diverticula blocked by faeces
- inflammation eventually allows bacterial invasion of diverticula walls
Uncomplicated vs complicated diverticulitis
- Uncomplicated: inflammation + small abscesses confined to colonic wall
- Complicated: larger abscesses, fistula + perforation
Where are most colonic diverticula found?
Why?
Sigmoid colon
Faeces is well formed at this point in the gut
What is Rovsing’s sign in appendicitis?
Pressure applied to left iliac fossa causing pain in right iliac fossa
What is a diverticulum?
A small pouch which sticks out from wall of large bowel
Describe the muscle in the appendix
Complete longitudinal layer of muscle
Complications of diverticulitis
- Haemorrhage
- Fistula
- Inflammation
- Abscess
- Perforation
