Appendix

Question 1

Q: What is the most common cause of acute abdomen in young adults?

Answer 1

A: Acute appendicitis

Question 2

Q: What is the most frequently performed urgent abdominal operation?

Answer 2

A: Appendectomy (surgical removal of the appendix).

Question 3

Q: In what age group does appendicitis most commonly occur?

Answer 3

A: 20-30 years of age.

Question 3

Q: What is the male to female ratio for appendicitis?

Answer 3

A: 3:2.

Question 4

Why is appendicitis rare in old age?

Answer 4

A: Due to atrophy of lymphoid tissue and fibrosis of the appendix, potentially leading to complete obliteration of the lumen.

Question 4

Q: What should be suspected if appendicitis occurs in an older patient?

Answer 4

A: Cancer of the cecum.

Question 5

Q: Why is appendicitis rare in children under 5 years old?

Answer 5

A: Due to the short, wide lumen of the appendix, which prevents obstruction and stasis.

Question 6

Q: Is appendicitis more common in urban or rural areas?

Answer 6

A: Urban areas, particularly in Western countries.

Question 7

Q: What is a likely contributing factor to the higher prevalence in Western countries?

Answer 7

A: Low-fiber diets, constipation, stasis, and infection.

Question 8

Causative Organisms/Route of Infection:

Q: What is the most common causative organism of appendicitis?

Answer 8

A: E. coli (85%).

Question 9

Q: What other organisms are commonly involved in appendicitis?

Answer 9

A: Staphylococcus and Streptococcus faecalis.

Question 9

Q: What is the usual route of infection in appendicitis?

Answer 9

A: Direct from the lumen (inside) of the appendix.

Question 10

Predisposing Factors/Obstruction:

Q: What is the most common and important predisposing factor for appendicitis?

Answer 10

A: Obstruction of the appendiceal lumen.

Question 10

Q: What are some causes of obstruction within the lumen of the appendix?

Answer 10

A: Hard feces (fecalith), pinworm infection (oxyuriasis), roundworm infection (ascaris), and foreign bodies.

Question 11

Q: What are some causes of obstruction external to the appendix?

Answer 11

A: Swelling of lymphoid tissue (often in response to viral infection), cancer of the cecum (in old age), and adhesions.

Question 11

Q: What does distension of the obstructed appendix promote?

Answer 11

A: Overgrowth of resident bacteria and subsequent invasion of the mucosa.

Question 12

Q: What are some causes of obstruction related to the wall of the appendix?

Answer 12

A: Rarely, tumors of the appendix or cecum.

Question 13

Q: What anatomical factor predisposes to appendicitis?

Answer 13

A: The narrow lumen of the appendix.

Question 14

Pathology/Types of Appendicitis:

Q: What are the two main types of acute appendicitis?

Answer 14

A: Acute obstructive appendicitis and acute non-obstructive appendicitis.

Question 15

Q: Which type of appendicitis is more common?

Answer 15

A: Acute obstructive appendicitis (3/4 of cases).

Question 16

Q: What are the stages of acute obstructive appendicitis?

Answer 16

A: Catarrhal (mucocele), suppurative (pyocele/empyema), and gangrenous.

Question 16

Q: Where does gangrene typically occur in obstructive appendicitis?

Answer 16

A: At the tip or at the site of obstruction.

Question 17

Q: In what patient population is non-obstructive appendicitis more common?

Answer 17

A: Constipated persons.

Question 18

Q: What is a serious complication of gangrenous appendicitis?

Answer 18

A: Generalized peritonitis.

Question 19

Q: What is the key difference in gangrenous appendicitis between obstructive and non-obstructive types regarding peritonitis?

Answer 19

A: In obstructive, perforation is rapid with no time for omental localization, leading to generalized peritonitis. In non-obstructive, perforation is delayed allowing omental localization, leading to localized peritonitis.

Question 19

Q: In which type of appendicitis is catarrhal inflammation confined to the mucosa?

Answer 19

A: Acute non-obstructive appendicitis.

Question 20

Fate and Recurrence: Q: What is the potential outcome for an acutely inflamed appendix?

Answer 20

A: It may resolve, but it is liable for recurrence.

Question 20

Local Complications: Q: What are some local complications of appendicitis?

Answer 20

A: Persistent obstruction leading to gangrene and perforation, appendicular mass (phlegmon), appendicular abscess, chronic appendicitis (recurrent subacute appendicitis), and fecal fistula.

Question 21

Q: What is the progression of untreated appendicitis if there is persistent obstruction?

Answer 21

A: Persistent obstruction can lead to gangrene and perforation.

Question 22

General/Systemic Complications: Q: What are some rare, general (systemic) complications of appendicitis?

Answer 22

A: Septicemia, toxemia, bacteremia, or pyemia, and portal pyemia (pylephlebitis).

Question 23

Q: What is portal pyemia (pylephlebitis)?

Answer 23

A: A grave (serious) condition caused by suppurative thrombophlebitis (infected blood clot) of the portal venous system.

Question 23

Q: What are the clinical features of portal pyemia?

Answer 23

A: Chills, high fever, low-grade jaundice, and later hepatic (liver) abscess.

Question 24

Clinical Picture - General: Q: What are the cornerstones of diagnosing acute appendicitis?

Answer 24

A: Proper history taking and physical examination.

Question 24

Symptoms - Pain: Q: What is the typical progression of pain in acute appendicitis?

Answer 24

A: It starts periumbilical (around the navel) as ill-defined, colicky (visceral) pain due to distension of the appendix. Within 6-10 hours, it shifts to the right iliac fossa (lower right abdomen) and becomes sharper (somatic pain) due to irritation of the parietal peritoneum.

Question 25

Q: What causes the initial periumbilical pain?

Answer 25

A: Distension of the appendix.

Question 25

Q: What aggravates the pain of appendicitis?

Answer 25

A: Movement or cough.

Question 26

Q: What causes the shift of pain to the right iliac fossa and its change in character?

Answer 26

A: Irritation of the parietal peritoneum.

Question 27

Symptoms - Other: Q: Are anorexia and nausea usually present in appendicitis?

Answer 27

A: Yes.

Question 28

Q: How common is vomiting in appendicitis?

Answer 28

A: It occurs in about 75% of patients.

Question 29

Q: Is vomiting more severe in obstructive or non-obstructive appendicitis?

Answer 29

A: More severe in the obstructive type.

Question 30

Q: What is the typical relationship between pain and vomiting in appendicitis?

Answer 30

A: Pain always precedes vomiting.

Question 31

Q: Is constipation usually present in appendicitis?

Answer 31

A: Yes.

Question 31

Q: When might diarrhea be present in appendicitis?

Answer 31

A: Early in the course of appendicitis (1 or 2 motions) or in cases of pelvic or retroileal appendicitis.

Question 32

Q: What happens to the pain when a patient with appendicitis coughs?

Answer 32

A: The pain becomes sharp and localized to the site of the appendix.

Question 32

Q: Why is appendicitis hard to diagnose in patients less than 5 years old?

Answer 32

A: The text states it is hard to diagnose in this age group but doesn't explain why on this page.

Question 33

General Examination Findings: Q: What is the typical temperature in uncomplicated appendicitis?

Answer 33

A: Mild fever <38°C

Question 33

Q: What does a higher temperature suggest?

Answer 33

A: Complications or other causes of acute abdomen.

Question 34

Q: Is tachycardia usually prominent in uncomplicated appendicitis?

Answer 34

A: No, it is not prominent (<100 beats per minute) and is proportionate to the fever.

Question 35

Q: What does a higher heart rate (tachycardia >100) suggest?

Answer 35

A: Complications.