Appendix Flashcards
What vessel provides blood supply to the appendix?
Appendiceal artery (branch of the ileocolic artery)
What is the mesentery of the appendix called?
Mesoappendix
How can the appendix be located if the cecum has been identified?
Follow the taenia coli down to the appendix.
The taeniae converge on the appendix.
What is appendicitis?
Inflammation of the appendix caused by obstruction of the appendiceal lumen, producing a closed loop with resultant inflammation that can lead to necrosis and perforation
What are the causes of appendicitis?
Lymphoid hyperplasia, fecalith, parasite, foreign body, tumor
What is the lifetime incidence of acute appendicitis in the US?
7%
What is the most common cause of emergent abdominal surgery in the US?
Acute appendicitis
How does appendicitis classically present?
- Periumbilical pain (intermittent and crampy)
- N/V
- Anorexia
- Pain migrates to RLQ (constant and intense), usually < 24 hours
Why does periumbilical pain occur in acute appendicitis?
Referred pain
Why does RLQ pain occur in acute appendicitis?
Peritoneal irritation
What are the signs and symptoms of acute appendicitis?
Signs of peritoneal irritation may be present; guarding; muscle spasm; rebound tenderness; obturator and psoas signs; low-grade fever; RLQ hyperesthesia
What is the obturator sign?
Pain upon internal rotation of the leg with the hip and knee flexed.
Seen in patients with pelvic appendicitis.
What is the psoas sign?
Pain elicited by extending the hip with the knee in full extension or by flexing the hip against resistance.
Seen classically with retrocecal appendicitis.
What is Rovsing’s sign?
Palpation or rebound pressure of the LLQ results in pain in the RLQ.
Seen in appendicitis.
What is Valentino’s sign?
RLQ pain/peritonitis from succus draining down to the RLQ from a perforated gastric or duodenal ulcer
What is McBurney’s point?
Point one third from the anterior superior iliac spine to the umbilicus (often the point of maximal tenderness)
What is the differential diagnosis of appendicitis?
Meckel’s diverticulum, Crohn’s disease, perforated ulcer, pancreatitis, mesenteric LAD, constipation, gastroenteritis, intussusception, volvulus, tumors, UTI, pyelonephritis, torsed epiploicae, cholecystitis, cecal tumor, diverticulitis
For women: ovarian cyst, ovarian torsion, TOA, mittelschmerz, PID, ectopic pregnancy, ruptured pregnancy
What lab tests should be performed for appendicitis?
CBC (increased WBC with left shift); UA (r/o pyelonephritis, renal calculus)
Can you have an abnormal UA with appendicitis?
Yes: mild hematuria and pyuria are common in appendicitis with pelvic inflammation, resulting in inflammation of the ureter
Does a positive UA rule out appendicitis?
No: ureteral inflammation resulting from periappendiceal inflammation can cause abnormal UA
What additional tests (besides CBC, UA) can be performed if the diagnosis of appendicitis is not clear?
Spiral CT; U/S (may see large, non-compressible appendix or fecalith); AXR
In acute appendicitis, what classically precedes vomiting?
Pain (in gastroenteritis, the pain classically follows vomiting)
What radiographic studies are often performed for appendicitis?
CXR: rule out RML or RLL pneumonia, free air
AXR: abdominal films are usually nonspecific, but calcified fecalith can be seen
What are the radiographic signs of appendicitis on AXR?
Fecalith, sentinel loops, scoliosis away from the right because of pain, mass effect (abscess), loss of psoas shadow, loss of preperitoneal fat stripe, and (rarely) a small amount of free air if perforated
With acute appendicitis, in what percentage of cases will a radiopaque fecalith be on AXR?
5%
What are the CT findings with acute appendicitis?
Periappendiceal fat stranding; appendiceal diameter > 6 mm; periappendiceal fluid; fecalith