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Gastrointestinal > Appendicitis + Diverticulitis > Flashcards

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

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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8
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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9
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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10
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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11
Q

Signs of appendicitis

A

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

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12
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
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13
Q

Treatment of appendicitis

A

Open appendectomy
Laprascopic appendectomy

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14
Q

What is McBurney’s point?

A

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

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15
Q

Where does the appendix classicaly lie?

A

McBurney’s point

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16
Q

Symptoms of diverticulosis

A

Asymptomatic

17
Q

Where does diverticulosis occur?

A

In colon (85% in sigmoid colon)
Where nutrient vessels (vasa recta) penetrate the bowel wall

18
Q

Cause of diverticulosis

A

Increased intra-luminal pressure
(Low fibre diet)

19
Q

What is diverticular disease?

A

Patient experiences symptoms/pain but no inflammation/infection

20
Q

What is acute diverticulitis

A

When the diverticula become inflammatory or perforate (+/- bleeding and abscess formation)

21
Q

Symptoms of diverticulitis

A
  • lower left iliac fossa pain
  • fever
  • bloating
  • constipation
  • haematochezia
22
Q

Signs of acute diverticulitis

A
  • localised abdominal tenderness
  • distension
  • reduced bowel sounds
  • signs of peritonitis if perforation
23
Q

Diagnosis of acute diverticulitis

A
  • blood test: raised WBC
  • pregnancy test to exclude ecoptic pregnancy
  • ultra sound
  • CT
  • colonoscopy if large haematochezia
  • elective colonoscopy to determine cause of symptoms
24
Q

Treatment of acute diverticulitis

A
  • antibitoics
  • fluid resuscitation
  • analgesia
  • surgery if perforation or large abscess needs to be drained
25
Q

What is haematochezia?

A

Bright blood in stool

26
Q

Cause of acute diverticulitis

A
  • entrance to diverticula blocked by faeces
  • inflammation eventually allows bacterial invasion of diverticula walls
27
Q

Uncomplicated vs complicated diverticulitis

A
  • Uncomplicated: inflammation + small abscesses confined to colonic wall
  • Complicated: larger abscesses, fistula + perforation
28
Q

Where are most colonic diverticula found?
Why?

A

Sigmoid colon
Faeces is well formed at this point in the gut

29
Q

What is Rovsing’s sign in appendicitis?

A

Pressure applied to left iliac fossa causing pain in right iliac fossa

30
Q

What is a diverticulum?

A

A small pouch which sticks out from wall of large bowel

31
Q

Describe the muscle in the appendix

A

Complete longitudinal layer of muscle

32
Q

Complications of diverticulitis

A
  • Haemorrhage
  • Fistula
  • Inflammation
  • Abscess
  • Perforation

Gastrointestinal (28 decks)

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