Appendix

Question 1

Anatomy of appendix:

Answer 1

• Postero-medial wall of the caecum
• valave of gerlach is the appendicular orifice
• mesoappendix: is a peritoneum - lower surface of the mesentry of the terminal ileum

Question 2

Appendicular artery is

Answer 2

Lower division of ileo-colic artery

Question 3

Position of appendix could be :

Answer 3

Retrocecal 
Paracecal
Subcecal
Pelvic
Promontoric (subileal)
Postileal 
Preileal

Question 4

Wallbridge anomaly types :

Answer 4

Type A : single cecum, and a partial duplication of the appendix with a single base
Type B1 : 2 completely separate appendices arise from a single cecum
Type B2: the 2nd appendix is usually found arising from the taenia coli of the wall of cecum
Type C: double cecum , each with its own appendix

Question 5

Size of appendix:

Answer 5

2-20cm
Average : 11cm
Diameter : 7-8mm

Question 6

Acute appendicitis:

Essentials of diagnosis :

Answer 6

1abd.pain (mc burneys point)
2anorexia, nausea , vomiting
3low grade fever
4leukocytosis

Question 7

Predisposing factors for appendicitis:

Answer 7

Age: 20-30 yrs
Socio economic condition: high profile
Lymphoid hyperplasia of the appendix
Fibrosis of the appendix

Question 8

Causes of appendicitis :

Answer 8

🔸obstructive causes - faecolith or stricture
🔸bacterial proliferation
🔸intestinal parasites 
🔸tumor 
🔸fibrotic stricture of the appendix

Question 9

Composition of faecolith:

Answer 9

Bacteria 
Calcium phosphate 
Epithelial debris 
Inspissated fecal material 
Foreign bodies

Question 10

Clinical findings of appendicitis:

Answer 10

Protean manifestation: may mimic a variety of conditions
Progression of symptoms is essential
▪️onset: vague abd. Discomfort
▪️followed: nausea , anorexia indigestion , vomiting , pain , mild , localized in the epigastrum
▪️pain: localized in RLQ+

Question 11

Examination of appendicitis :

Answer 11

• tenderness on coughing , localized in RLQ
• localized tenderness on palpation
• slight muscular rigidity
• rebound tenderness referred to the same area
• rectal and pelvic examination NORMAL
• low fever <38

Question 12

Retrocecal appendicitis examination:

Answer 12

Poorly localized pain
No discomfort on coughing , walking
Diarrhea
Urinary symptoms (hematuria, urinary frequency)
Pain in the flank (tenderness in one finger examination )

Question 13

Pelvic appendicitis examination:

Answer 13

May simulate gastroenteritis
Nausea vomiting and diarrhea
Negative abd. examination
IMPORTANT= repeated pelvic (rectal) examination

Question 14

Perforation of the appendix :

Answer 14

If the fever is >38.9
&
WBC>18,000

Question 15

Perforation of the appendix lead to -> peritonitis:

Answer 15

Extreme of age 
Immunosuppression
Diabetes mellitus 
Faecolith obstruction
Pelvic appendix 
Previous abd. Surgery

Question 16

Symptoms -inflamed appendix :

Answer 16

Pain - initially periumbilical region then pain shift to right iliac fossa
Anorexia
Nausea / vomiting

Question 17

Clinical signs of appendicitis:

Answer 17

Pyrexia -low grade after 6 hrs
Tenderness ( in RIF)
Muscle guarding
Rebound tenderness “BLUMBERG’s SIGN”
Foul breath (bad smell)
Tachycardia : perforation, gangrene and peritonitis
**Rovsing’s sign ( palpation of LLQ causes pain in RLQ
** obturator sign( pain on passive internal rotation of the flexed thigh )

Question 18

Tenderness of appendicitis will be localized in:

Answer 18

Mc Burney’s point

Question 19

ALVARDO score :

SYMPTOMS/ SIGNS/ LAB TESTS

Answer 19

-From 1-10 , symptoms , sign , lab tests
▪️7-10= strongly predictive of appendicitis
▪️5-6= equivocal
▪️1-4= appendicitis can be ruled out

Question 20

X ray findings of appendicitis :

Answer 20

Air- fluid levels or isolated ileus
Fecaliths
Free air in the peritoneum
Signs of peritonitis

Question 21

Appendicitis in pregnancy:

Diagnosis:

Answer 21

Difficult due to =

• high position of the appendix
• all usual signs are present
• difficult to interpret leukocytosis
• appendectomy is mandatory and urgent

Question 22

Complications if appendicitis:

Answer 22

• perforation
• peritonitis
• appendiceal abscess
• pylephlebitis (suppurative thrombophlebitis of portal vein)

Question 23

Appendiceal abscess treatment :

Answer 23

ANTBX + diet low in residue

Drainage of abscess -/+ appendectomy

Question 24

Treatment of acute appendicitis:

5

Answer 24

✅ absolute bed rest & NPO 
✅ IV fluid supplement 
✅analgesics (pethidine-opiod) 
✅ANTBX( ofloxacine+ orinidazole) 
✅appendectomy ( within 24 hrs ASAP)

Question 25

Indications of appendectomy:

Answer 25

• acute appendicitis
• recurrent appendicitis
• mucocele of appendix ( dilation of the appendix lumen as a result of mucin accumulation)
• carcinoma confined to the mucosa

Question 26

Incision in appendectomy:

Answer 26

🔸grid iron and lanz incision - muscle splitting incisions
🔸bikini incision- slightly lower than lanz incision
🔸rutherford morison-

Question 27

Chronic appendicitis :

Answer 27

Chronic inflammation in the wall due to multiple acute attacks
-Chronic abd. Pain in the RLQ
-Possible recurrent attack of acute appendicitis
-other problems
-

Question 28

Treatment of chronic appendicitis:

Answer 28

Appendectomy -debatable

Question 29

Classifications of the appendix tumors:

Answer 29

▪️Benign: fibroma , leyomyoma, lypoma
▪️malignant : carcinoma
▪️borderline: carcinoid , mucocele

Question 30

Treatment for carcinoid tumor of appendix:

Answer 30

✅Appendectomy 
✅ R. Hemicolectomy is indicated when: 
-tumor is >2cm in size 
-involves the base of appendix 
-involves the caecal wall or mesoappendix
-LNs are involved

Question 31

Mucocele :
+ clinical examination
+treatment

Answer 31

*not true tumors: 
Chronic distention of the appendix plus continuous mucus secretion 
*clinical examination: 
RLQ discomfort 
Mass
Rupture in peritoneum 
*treatment: 
Appendectomy

Question 32

Appindicular lump gold standard treatment :

Answer 32

Ochsner -sherren regimen treatment