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Appendicitis + Diverticulitis Flashcards

1
Q

What is the appendix?

A

Diverticulum off the caecum
Has complete longitudinal layer of muscle

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2
Q

Blood supply of the appendix

A

Appendicular artery
Through the mesoappendix from the ileocolic branch of SMA

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3
Q

What are the possible locations of the appendix?

A

Retro-caecal
Pelvic
Sub-caecal
Para-ileal (pre or post)

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4
Q

What is the primary cause of appendicitis?

A
  • 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
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5
Q

What is faecolith?

A

Hardened stool

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6
Q

What can a rupture appendix cause?

A

Peritonitis

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7
Q

Describe the muscle in the appendix

A

Complete longitudinal layer of muscle

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8
Q

What is a cause of appendicitis other than a blockage?

A

Viral or bacterial infection
caused by mucosal changes that allow invasion of appendiceal walls

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9
Q

Symptoms of appendicitis

A
  • 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
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10
Q

What position of the appendix may you not get right iliac fossa pain in appendicitis?
Where is pain felt instead?

A

rectro-caecal or pelvic
-parietal peritoneum in RIF doesn’t come into contact with inflamed appendix
- supra-pubic pain, right sided rectal or vaginal

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11
Q

Pain in appendicitis if appendix if in retro-caecal or pelvic position

A

Supra pubic pain
Right sided rectal
Or vaginal pain

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12
Q

Signs of appendicitis

A

Patients appear slightly ill
- slight fever
- tachycardia
- localised right quadrant tenderness
- rebound tenderness in right iliac fossa
- percussion tenderness
- guarding
- patient lies still
- rovsing’s sign
- psoas sign

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13
Q

what is rovsing sign?

A

RIF pain on palpation of LIF

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14
Q

what is psoas sign?
what is this suggestive of?

A
  • RIF pain with extension of righ hip
  • suggestive of retrocaecal appendicitis
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15
Q

Diagnosis of appendicitis

A
  • raised WBC in FBC
  • history/physical exam (especially rebound tenderness)
  • pregnancy test/urine dip to rule out pregnancy or UTI
  • CT or USS
  • if investigations are negative, diagnostic laprascopy
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16
Q

differential diagnosis of appendicitis

A
  • ectopic pregnancy
  • ovarian cysts
  • meckel’s diverticulum
  • mesenteric adenitis
  • ureteric stone
  • testicular torsion
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17
Q

what is mesenteric adenitis?
presentation

A
  • inflamed abdominal lymph nodes
  • associated with tonsillitis or UTRI
  • presents with abdominal pain
  • normally in young children
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18
Q

what is an appendiceal mass?

A
  • when the omentum surrounds + sticks to the inflamed appendix
  • this forms a mass in RIF
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19
Q

treatment of appendiceal mass

A

inital antibiotics before surgery

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20
Q

Treatment of appendicitis

A
  • Laparoscopic appendectomy
  • possible trial of abx
21
Q

Complications of appendicectomy

A
  • bleeding
  • infection
  • pain
  • scarring
  • damage to bowel or bladder
  • anaesthetic risks
  • VTE
22
Q

What is McBurney’s point?

A

2/3 of way from umbilicus to ASIS
Where appendix classically lies

23
Q

Where does the appendix classicaly lie?

A

McBurney’s point

24
Q

what is diverticulosis?

A

presence of diverticula without inflammation or infection

25
pathophysiology of diverticula
- the large intesine has a layer of circular muscle - it is weakened where blood vessels penetrate the muscle - increase pressure inside the lumen over time can form gaps - the gaps allow mucosa to herniate through the muscle wall > diverticula
26
Symptoms of diverticulosis
Asymptomatic
27
Where does diverticulosis occur?
In colon (85% in sigmoid colon) Where nutrient vessels (vasa recta) penetrate the bowel wall
28
Risk factors of diverticulosis
- low fibre diet - obesity - NSAID use - increasing age
29
Diagnosis of diverticulosis
incidental findings on colonoscopy or CT
30
Management of diverticulosis
- increased fibre in diet - weight loss - bulk forming laxatives *ispaghula husk*
31
Why do diverticula not form in the rectum?
It has an outer longitudinal muscle layer that completely surrounds the rectum diameter which provides more support
32
What is diverticular disease?
Patient experiences symptoms/pain but no inflammation/infection
33
What is acute diverticulitis
When the diverticula become inflammatory or perforate (+/- bleeding and abscess formation)
34
Symptoms of diverticulitis
- lower left iliac fossa pain - fever - bloating - diarrhoea - N+V - haematochezia
35
Signs of acute diverticulitis
- localised abdominal tenderness - distension - reduced bowel sounds - signs of peritonitis if perforation
36
Diagnosis of acute diverticulitis
- **blood test**: raised WBC, group + save, ?faecal calprotectin - **pregnancy test** to exclude ectopic pregnancy - **urine dipstick** - **ultra sound** - **CT abdo-pelvis**
37
Staging of diverticulitis
Hinchey classification
38
management of acute uncomplicated diverticulitis
- **oral co-amoxiclav** 5 days - c**lear fluids** - **analgesia** (avoid NSAIDs + opiates) - **follow up** in 2 days to review
39
Management of complicated diverticulitis
- nil by mouth - IV abx - IV fluids - analgesia - surgery *Hartmann's procedure*
40
who is surgical intervention warranted for people with diverticulitis?
- evidence of perforation - sepsis not responding to abx - failure to improve after conservative management
41
What does a Hartmann's procedure involve?
sigmoid colectomy with formation of an end colostomy
42
Cause of acute diverticulitis
- entrance to diverticula blocked by faeces - inflammation eventually allows bacterial invasion of diverticula walls
43
Uncomplicated vs complicated diverticulitis
- **Uncomplicated**: inflammation + small abscesses confined to colonic wall - **Complicated**: larger abscesses, fistula + perforation
44
Where are most colonic diverticula found? Why?
Sigmoid colon Faeces is well formed at this point in the gut
45
Complications of diverticulitis
- Haemorrhage - Fistula - Inflammation - Abscess - Perforation - peritonitis - ileus/obstruction - diverticular stricutre
46
What is mesenteric adenitis?
Inflamed lymph nodes within the mesentery Similar presentation of appendicitis
47
Presentation of mesenteric adenitis
- often follows viral infection - similar presentation to appendicitis - corzyal symptoms due to recent viral infection - high fever - RIF pain - no anorexia or vomiting
48
Compare appendicitis + mesenteric adenitis
Mesenteric adenitis: - starts in RIF - coryzal symptoms due to recent viral infection - no anorexia + vomiting - higher fever - self limiting 24-48 hrs
49
Management mesenteric adenitis
None needed - self limiting 24-48 hours

Gastrointestinal (30 decks)

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