Appendicitis, Diverticulitis, & Mesenteric Ischemia Flashcards
appendicitis epidemiology
- MC surgical procedure
- 10% of population
- teens to 20s
appendicitis etiology
- appendic fecalith obstruction
- MC in kids = submucosal hyperplasia of lymphoid follicles
- MC in adults = fecalith
- FB
- strictures of neospams
appendicitis pathophysiology
- incr. intraluminal pressure
- lymphatic/venous obstruction
- edema
- ischemia
- invasive infx
- perforation
anatomical variations of the appendix
- MC at McBurney’s Point
- retrocecal = posterior to cecum or ileum
- pelvic = inferior, in RLQ
appendicitis S+S
- visceral pain, begins at pm, but localizes to RLQ
- anorexia
- low grade fever
- n/v
- onset less than 24hr
- leukocytosis
- “downward urge”
- TTP + rebound tenderness
- (+) Rovsing, Psoas, +/or obturator sign
- indirect rebound tenderness
- DRE
- absscess
appendicitis unusual presentation
- retrocecal
- pelvic
- women of childbearing age
Describe the presentation of retrocecal appendicitis
- less pain, vomining, muscle rigidity
- pain starts in RLG
- (+) diarrhea/urinary frequency
Describe the presenation of pelvic appendicitis
- presents like gastroenteritis
- diffuse pain, vomiting, diarrhea
- R tenderness on DRE
Describe the presentation of appendicitis in women of childbearing age
- adnexal tenderness, palpable mass
- MC non-GYN surgical emergency in pregos
appendicitis diagnostic studies
- Labs: CBC, electrolytes, UA, HCG
- US
- abd CT
appendicitis tx
- preop IV fluids
- antipyretic
- NG suction if pt has peritonitis
- abx
- appendectomy
- drainage of abscess
appendicitis complications
- perforation
- post-op infx
- abscess
define diverticulitis
- inflammation + infection associated w/ diverticula
diverticulitis pathophysiology
- not well understood
- sigmoid colon
- incr. fiber = decr. risk
diverticulitis types
- uncomplicated
- complicated
- hemorrhagic
- giant colonic
- R sided
diverticulitis S+S
- visceral pain starts in hypogastric region
- anorexia, n/v
- pain goes to LLQ (TTP)
- bowel changes
- fever
- palpable mass
- DRE = L tenderness + (+) occult blood
diverticulitis unusual presentation
- R sided = in younger pts, mistaken for appendicitis
- hemorrhagic = elderly; tx via resucetate, transfuse, localized bleeding site
- w/ abscess = CT drainage if over 2cm or open laporotomy, IV abx
- w/ perforation = dx w/ upright abd xr, tx = 2 stage open laparotomy
- w/ obstruction = conservative tx or surgical resection
- w/ fistula = ID anatomy
diverticulitis diagnostic studies
- labs: leukocytosis
- plain upright abd XR
- CT w/ contrast
diverticulitis tx
- broad spectrum abx
- clear liquid diet
- if unable to po, admit w/ IV fluid + NOP, advance diet prn
mesenteric ischemia etiology
superior mesenteric a. thrombosis or embolus
mesenteric ischemia epidemiology
elderly
mesenteric ischemia clinical presentation
- severe, constant, abd pain associated w/ vomiting/diarrhea usually epigastric or periumbilical
- pain out of proportion to amt of tenderness
- underwhelming PE
- associated vasc. dx
mesenteric ischemia work-up
- CTA or MRA
- angiography
- CBC = elevated WBC (L shift)
- metabolic acidosis
- hyperkalemia
mesenteric ischemia tx
embolectomy
peritonitis definition
sudden or recent onset of unexpected abd pain, usually w/in 24-78hr
peritonitis S+S
- based on location of pain
- worse w/ movement therefore pts lie still
- n/v
- fever/chills
- anorexia
- high-pitched tinkles of obstruction or absence of sounds
peritonitis diagnostic studies
- Labs: CBC, UA, electrolytes, H+H, LFTs, pancreatic studies
- CT
- US
peritonitis tx
refer to general surgery
