Appendix Flashcards
What is the appendix?
Under-developed distal cecum
Located where tenia join at cecum
True diverticula - outpouch of the distal cecum
Most common location of Appendix?
McBurney’s point - RLQ
When does appendicitis most frequently occur? Age?
2nd and 3rd decades of life
Incidence highest in 10-19 year old age group
Male > Female
Pathogenesis of Appendicitis
Inflammation -> Ischemia -> Perforation -> Peritonitis/Abscess
-pts usually present BEFORE perf and abscess
Appendicitis pathogenesis related to what?
An obstructed process at the lumen of the appendix
- obstruction by fecolith, stricture, foreign body
- dietary factors (low fiber, highly refined CHO) - junk food
- bacterial proliferation
- obstruction by tumor
- infective trigger and seasonal variation
- lymphoid hyperplasia
What organisms are involved in gangrenous and perforated appendicitis?
E. Coli, Peptostrepto, B. Fragilis, and Pseudomonas
Common presentation of appendicitis
Periumbilical pain that moves to right iliac fossa pain
Colicky (waning) pain that changes to dull constant pain
Periumbilical pain -> 1 or 2 episodes of vomiting -> right iliac fossa pain
ALSO HAVE ANOREXIA AND NAUSEA PROGRESSION
Hx workup for appendicitis
- abd pain
- N/V
- low grade fever
- anorexia
- malaise
- diarrhea
Family hx and appendicitis
1/3 of children have a 1st degree relative with similar story
Appendicitis Physical Work-up
FEVER IS LOW GRADE
- McBurney’s Point Tenderness
- Rovsing’s sign
- Psoas Sign (RLQ pain with passive right hip extension)
- Obturator Sign
- Pointing Sign
Appendicitis Lab Workup
CBC w/diff
Electrolytes
LFT’s
Urinalysis
Appendicitis Imaging
Abd X-ray
U/S - let’s you know if inflammation at site of appendix
CT scan
Appendicitis Tx
- NOTHING BY MOUTH (NPO)
- TREATMENT IS SURGICAL (but have to prepare)
To prepare do IVF and IV Abx broad spectrum (3rd ceph or Gentamycin or Metro+Flagyl)
When do you NOT operate for Appendicitis?
Peritonitis
Presence of appendicular mass
Resolved - elective at a later time
IF NO SX’S DON’T OPERATE
What must you do before appendicitis surgery?
Need to stabilize pt - give IVF and broad spectrum Abx
Appendicitis/Appendectomy complications
- perforation
- abscess intro-abdominal
- fecal fistula
- DVT
- Hernia
Complications of surgery:
- bleeding
- wound infection (MOST COMMON)
- bowel injury
What is the most common complication of appendix surgery?
Wound infection
What is the blood supply of the small intestine?
Superior Mesenteric Artery
-source of blood supply for Duodenum, jejunum, ileum, cecum, ascending colon and proximal 2/3 transverse colon
Superior Mesenteric artery supplies what?
Duodenum, jejunum, ileum, cecum, ascending colon, and proximal 2/3 transverse colon
Signs of Small Bowel Obstruction
- Abd distention
- Tinkering bowel sounds
- possible bilious vomiting
- colicky central abd pain
Evidence of small bowel strangulation/ischemia or perforation
Peritonism and fever
When does a small bowel obstruction occur?
When the normal flow of intestinal contents is interrupted
what is the most common cause of SBO in the U.S.?
Postop adhesions
What is the most common cause of SBO in developing world?
Hernias