Appendix

Question 1

What vessel provides blood supply to the appendix?

Answer 1

Appendiceal artery - branch of the ileocolic artery

Question 2

Name the mesentery of the appendix

Answer 2

Mesoappendix (contains appendiceal artery)

Question 3

How can the appendix be located if the cecum has been identified

Answer 3

Follow the taenia coli down to the appedix

Question 4

What is it?

Answer 4

Inflammation sec to obstruction of the lumen, producing closed loop which can lead to necrosis and perforation

Question 5

Causes of AP

Answer 5

Lypmhoid hyperplasia, fecalith

Question 6

Lifetime incidence

Answer 6

~7%

Question 7

Classic presentation

Answer 7

1. Periumbilical pain (intermittent and crampy)
2. Nausea/vomiting
3. Anorexia
4. Pain migrates to RLQ

Question 8

Why does RLQ pain occur?

Answer 8

Peritoneal irritation

Question 9

Pain upon internal rotation of the leg with the hip and knee flexed; seen in patients with pelvic appendicitis
PELVIC AP

Answer 9

Obturator sign

Question 10

Pain by extending the hip with the knee in full extension or by flexing the hip against resistance
RETROCECAL AP

Answer 10

Psoas

Question 11

Palpation or rebound pressure of the LLQ results in pain in the RLQ

Answer 11

Rovsing’s sign

R - REBOUND

Question 12

Diff diagnosis for EVERYONE

Answer 12

Meckel’s diverticulum, Crohn’s disease, perforated ulcer, pancreatitis etc.

Question 13

Diff dx for females

Answer 13

Ovarian cyst
ovarian torsion
Tuboovarian abscess
mittelschmerz
PID
ectopic pregnancy
ruptured pregnancy

Question 14

Lab tests

Answer 14

WBC> 10,000 in 90% of the cases
LEFT SHIFT
Urinalysis: to evaluate for pyelonephritis and renal calculus

Question 15

Can you have an abdnormal UA in AP?

Answer 15

YES

mild hematuria and pyuria are common with pelvic inflammation, resulting in inflammation of the ureter

Question 16

AXR signs of AP?

Answer 16

fecalith
sentinel loops
Soliosis
loss of psoas shadow

Question 17

fecalith is (+) for ony __% of the time

Answer 17

~ 5% only

Question 18

CT scan finding

Answer 18

periappendiceal fat stranding, appendiceal diameter >6mm

Question 19

Tx for nonperforated acute AP

Answer 19

Prompt appendectomy, 24 hours of antibiotics, discharge after POD#1

Question 20

Treatment for perforated AP

Answer 20

IV fluid resuscitation and prompt Appendectomy, post op Antibiotics 3-7 days. wound is left open in most cases of perforation after closing the fascia (heal by secondary intention)

Question 21

Antibiotic for nonperforated

Answer 21

Anerobic coverage

Question 22

Perforated antibiotics

Answer 22

Broad spectrum: Cipro, Clinda, Penicillin

Question 23

Risk of perforation?

Answer 23

~25% by 24 hours of onset of symptoms, 50% by 36, 75% by 48hrs

Question 24

Most common general surgical abdominal emergency in pregnancy?

Answer 24

Appendicitis

Question 25

Complications?

Answer 25

Pelvic abscess
Liver abscess
free perforation
Portal pylethrombophlebitis

Question 26

% of the population that has retrocecal, retroperitoneal appendix

Answer 26

~15%

Question 27

% of negative appendectomies acceptable

Answer 27

20%

Question 28

What bacteria are associated with “mesenteric adenitis” that can closely mimic acute appendicities

Answer 28

Yersinia enterolitica

Question 29

What is an “incidental appendectomy”

Answer 29

Removal of normal appendix during abdominal operation for different procedure

Question 30

Most common post op complication of AP

Answer 30

Wound infection