Appendix Flashcards
What is an acute appendicitis?
Acute inflammation of the appendix
What are causes of acute appendicitis?
Idiopathic Obstruction with faecoliths (dehydration) within lumen Lymphoid hyperplasia Parasites (very rarely) Tumours (rare)
What is a faecolith?
Hard stony mass of faeces
What is the commonest tumour of the appendix?
Carcinoid
What are other tumours of the appendix besides carcinoid?
Appendiceal mutinous neoplasm
Sessile serrate mucosal lesions
What are histopathological features of a carcinoid tumour of the appendix?
Crypt of Lieberkuhns
Stains for Chromogran
The metastatic risk of carcinoid tumours of the appendix are proportional to?
Size
How do you manage a carcinoid tumour of the appendix if it is <1 cm in size?
Appendectomy alone
How do you manage a carcinoid tumour of the appendix if it is >2 cm in size?
Complete right hemi
What is the pathophysiology of acute papnedicitis?
Acute inflammation (neutrophils) must involve muscle coat - mucosal ulceration serial congestion (exudate) - pus in lumen
How does the appendix become inflamed and infected?
Invasion of appendix wall by gut flora
What is the epidemiology of acute appendicitis?
Most common in children/young adulthood (another peak in elderly)
How are symptoms of acute appendicitis?
Periumbilical pain - moves into RIF
Pain aggravated by movement
Nausea and vomiting, anorexia
What is Rovsing’s sign?
Press on left = pain on right
What is Psoas’ sign?
Patient tries to keep hip flexed as it lifts inflamed appendix off psoas
What is Obturator’s signs?
If appendix is touching obturator interns, flexing the hip internally bitting will cause pain
What are signs of acute appendicitis?
Mild pyrexia
Mild tachycardia
Localised RIF pain
Guarding
What are complications of acute appendicitis?
Rupture of appendix - faecal matter escape into peritoneal cavity - peritonitis (possibly fatal)
Abscess, fistula sepsis, liver abscess
Small bowel adheres, phlegmonous mass
What are investigations for acute appendicitis?
USS for women and kids or CT (if still unsure)
AXR to exclude other causes
Bloods (FBC, CRP, WCC)
Urinalysis
Pregnancy test to exclude ectopic pregnancy
How do you treat an acute appendicitis?
Analgesia, antipyretics, theatre antibiotics, appendectomy (best = laprascopic)
Metronidazole and cefuroximide
What are features of an appendix mass?
Tachycardia, worsening pain, vomiting or copious NG aspirates (ileus)
Increase in size
How do you treat an appendix mass?
Abx +/- operate
An appendix abscess is usually?
Delayed and liquidised
What are possible complications of an appendix abscess?
Pelvic abscess Wound infection Intra-abdominal abscess Ileus Respiratory DVT/PE Portal pyaemia Faecal fistula Adhesions Right sided inguinal hernia
How do you treat an appendix abscess?
Radiological drian
