Appendix Disease

Question 1

What is the most imp part in diagnosis of acute appendicitis?

Answer 1

Physical exaimnation

Question 2

What are the differential diagnosis for appendicitis in children?

Answer 2

MIAMI NUT
• Mesenteric adenitis(inflamed lymph node in the abdomen-Abdominal pain in children)
• Acute gastroenteritis
• Intussusception
• Meckel’s diverticulitis
• Inflammatory bowel disease
• Testicular torsion in men
• Nephrolithiasis
• Urinary tract infection

Question 3

What are the differential diagnosis for appendicitis in elderly?

Answer 3

**Acute diverticulitis
-Gynecological problems
-Malignant diseases
-In neutropenic patients, typhlitis (neutropenic enterocolitis)
-malignant disease

Question 4

Which sign is indicative of appendicitis?

Answer 4

-Mc Burney’s sign (Defense pain in right lower quad)

-Rovsing’s sign (Rebound pain when pressing on left lower quadrant then withdrawal pain is felt in RLQ)

-obturator sign

-psoas sign

Question 5

What are the GIS symptoms in APpenedicitis?

Answer 5

Anorexia(pt who is hungry and asking for food doesn’t have appendicitis)
**nausea
Vomiting

Question 6

What are the 3 abdominal palpation in appendicitis?

Answer 6

Rovsing’s sing
Obturator sign
Psoas sign

Question 7

What are the lab findings in appendicitis?

Answer 7

• Leukocytosis (>10,000 cells/mm3)
• CRP (C-reactive protein)
• No symptoms, signs or laboratory results are distinctive for appendicitis.

Question 8

What are the **findings of appendicitis?

Answer 8

-Nausea and vomiting(due to distention due to intraluminal pressure increase bcz of appendicitis obstruciton)

-rebound tenderness (Rovsing’s sign)

-pain in Mcburney’s

-Leukocytosis

Question 9

What is imp to suspect in differential diagnosis of acute appendicitis in elderly?

Answer 9

Neoplasm/malignant disease

Question 10

What is the most common tumor of the appendix?

Answer 10

Carcinoid tumor

Question 11

What factor of the tumor is imp in carcinoid tumor of the appendix?

Answer 11

Tumor size

Question 12

Patients with appendiceal adenocarcinoma are associated with ……. And ………

Answer 12

synchronous and metachronous neoplasms

[Malignancies that occur within 6 months of the first primary tumor are defined as synchronous while those that develop after the first 6-month interval are defined as metachronous ]

Question 13

Which type of pain is present Mc Burney?

Answer 13

Defense

Question 14

What are the direct percussion?

Answer 14

Mcburney’s sign

Question 15

What is the indirect rebound pain in appendicitis?

Answer 15

Rovsing’s sing

Question 16

The mucin filling of the peritoneal cavity in mucocele is called?

Answer 16

Pseudomyxoma peritonei**

Question 17

What are the postoperative complication of appendectomy?

Answer 17

[Bleeding-infection-abscess-
stump appendicitis-Fistula]
• Surgical site infection (superficial/deep)
• Intraabdominal abscess
• Bleeding
• Gastrointestinal Fistula
• “Stump appendicitis” (Remaining stump should not be >0.5 cm)

Question 18

In appendix carcinoid the malignant potential is related to?

Answer 18

Tumor size

Question 19

Wht is the differential diagnosis of appendicitis in children?

Answer 19

MIAMI NUT
Mesenteric adenitis
Intussusception
Acute gastroenteritis
Meckel’s diverticulitis
Inflammatory bowel disease

Nephrolithiasis
Urinary tract infection
Testicular torsion

Question 20

Etiology of appendicitis

Answer 20

**Fecal stasis

Neoplasm

Parasites (Askaris)

**Appendicitis Luminal obstruction–>pressure inc–>distention(–>nausea and vomiting)

Inc in gram negative or anaerobic bacteria

Question 21

Know obturator and psoas sign

Question 22

Benign tumor of mucocele is treated by:

Answer 22

Appendectomy

Question 23

Malignant tumor of mucocele is treated by:

Answer 23

Left hemilectomy and ….

Question 24

What is tx for mucocele

Answer 24

HIPEC(Hyperthermic (or Heated) Intraperitoneal Chemotherapy) done after surgery

Question 25

………is not emergency is is when the omentum covers the ruptured appendix forming a tumor-like mass

Answer 25

Plastrone appendicitis

Question 26

In adenocarcinoma, the tumor malignancy potential is dependent on..?

Answer 26

The depth of layer invasion

Question 27

which dx tests are used to confirm appendicitis in a stable pt before surgery?

Answer 27

CT and U/S