Appendicitis - lower GI Flashcards
What is the name for a very hard piece of faeces?
Faecolith
What is the pathophysiology of appendicitis?
- Obstruction of lumen by a faecolith (very hard piece of faeces)
- –> Appendix constricts to try + drive faecolith out of appendix
- –> increased pressure in bowel wall
- –> inference with blood supply (ischaemic changes)
- –> decreases walls resistance to bacterial infection
- –> Inflammation of wall (via bacterial invasion)
Which 2 organisms are commonly associated with appendicitis?
- E. Coli
- Streptococci
Describe the processes that occur during appendicitis.
- earliest lesion: ulceration of mucosa surface
- Interference with circulation
- –> to areas of necrosis and perforation with spread to the peritoneal cavity
- walled off infection –> localised abscess (localised area of tissue necrosis) which can eventually
- –> to generalised peritonitis
Are symptoms associated with obstruction poorly localised or well localised?
poorly localised
Is pain associated with peritonitis similar to obstruction?
NO - obstruction = poorly localised
Describe the progression of pain in appendicits.
abdominal pain
- initially was generalized,
- but then localized to the right lower quadrant.
What are some visual signs of appendicitis seen during autopsy?
- yellow/tan exudate
- hyperaemia
note: hyperaemia = excess of blood in vessels supplying a structure
What are some microscopic signs of acute appendicitis?
- mucosal inflammation
- mucosal ulceration
- necrosis
- neutrophilic exudate.
What can be seen on blood results that indicates appendicitis?
raised WBC
What is the clinical presentation of appendicitis?
- Begins with generalised central abdominal pain (referred pain)
- Pain shifts to right iliac fossa over a few hours to a few days, and is more severe
- loss of appetite
- nausea
- vomiting
What is the clinical presentation of generalised peritonitis?
- generalised abdominal pain
- nausea and vomiting
- sweating,
- rigors