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Nelson - The Digestive System > Ch. 343 - Acute Appendicitis > Flashcards

Ch. 343 - Acute Appendicitis Flashcards

1
Q

MC acute surgical condition in children

A

Acute appendicitis

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2
Q

Mainstay of treatment of acute appendicitis

A

Prompt appendectomy

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3
Q

T/F Incidence of appendicitis increases with age

A

T

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4
Q

Appendicitis is diagnosed in ___% of children presenting to the ER for evaluation of abdominal pain

A

1-8%

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5
Q

T/F Mortality rate of acute appendicitis is high

A

F, low, less than 1%

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6
Q

T/F Morbidity rate of acute appendicitis is high

A

T

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7
Q

T/F Children have a higher perforation rate of appendicitis than adults

A

T, 82% for children younger than 5, approaching 100% in infants

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8
Q

Complications brought about by acute appendicitis

A

1) Perforation 2) Abscess formation 3) Peritonitis 4) Pylephlebitis (due to bacterial invasion of mesenteric veins to involve the portal vein and SMV) 5) Thrombosis 6) [Fistula formation>] Liver abscess and abscess formation in adjacent organs 7) Scrotal cellulitis and abscess through a patent processus vaginalis (congenital indirect inguinal hernia) 8) Small bowel obstruction

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9
Q

Final common pathway of appendiceal inflammation and its complications

A

Invasion of the appendiceal wall by bacteria

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10
Q

Factors implicated in the initiation of acute appendicitis

A

1) Luminal obstruction 2) Enteric infection 3) Blunt abdominal trauma 4) Cystic fibrosis (due to abnormally thickened mucus)

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11
Q

Implicated in luminal obstruction that leads to acute appendicitis

A

1) Inspissated fecal material 2) Lymphoid hyperplasia 3) Ingested foreign body 4) Parasites 5) Tumors (e.g. carcinoid tumors of the appendix)

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12
Q

Pathophy of acute appendicitis caused by luminal obstruction

A

Luminal obstruction > bacterial proliferation and continued secretion of mucus > elevated intraluminal pressure > lymphatic and venous congestion and edema > impaired arterial perfusion > ischemia of wall of appendix > bacterial invasion of appendiceal wall > necrosis

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13
Q

Clinical disease progression of appendicitis

A

Simple appendicitis > gangrenous appendicitis > appendiceal perforation

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14
Q

Acute appendicitis is most common at what age group

A

Teenagers/older children/specifically between 12 and 18 years old (less than 5% of cases in less than 5y/o, less than 1% of cases in less than 3 y/o)

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15
Q

Why is acute appendicitis most common during teen years

A

Submucosal lymphoid follicles, which can obstruct appendiceal lumen, are few at birth but multiply steadily during childhood and peak in number during teen years

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16
Q

T/F Majority of specimens from cases of acute appendicitis demonstrate luminal obstruction

A

F, less than 50%

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17
Q

Pathophy of acute appendicitis caused by enteric infection

A

Mucosal ulceration > invasion of the appendiceal wall by bacteria

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18
Q

Organisms implicated in acute appendicitis

A

Yersinia, Salmonella, Shigella, infectious mononucleosis (EBV), mumps, coxsackie B, adenovirus, Ascaris

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19
Q

T/F Appendicitis is common in neonates

A

F, RARE, hence occurrence warrants diagnostic evaluation for CF and Hirschprung disease

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20
Q

“A primary focus in the management of acute appendicitis is

A

Avoidance of sepsis and infectious complications

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21
Q

Why is “Avoidance of sepsis and infectious complications” a primary focus in the management of acute appendicitis

A

Leads to increased morbidity

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22
Q

T/F Bacteria can be cultured from the serial surface of the appendix before microscopic or gross perforation

A

T

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23
Q

Localized abscess or inflammatory mass formed subsequent to perforation by the momentum and adjacent loops of bowel

A

Phlegmon

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24
Q

Reason why young children are often unable to control local infection

A

Poorly developed omentum

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25
Q

T/F Classic presentation of acute appendicitis represents majority of acute appendicitis cases in children

A

F, less than 50%; majority are atypical

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26
Q

Acute appendicitis in children typically begins with

A

Generalized malaise and anorexia

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27
Q

Appendiceal perforation in children is likely to occur within

A

48 hours of onset of illness

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28
Q

Consistently the primary and often first symptom of appendicitis in children

A

Abdominal pain, begins hours after onset of illness

29
Q

Typical pain of appendicitis in children

A

1) Vague 2) Poorly localized 3) Unrelated to activity or position 4) Colicky 5) Periumbilical

30
Q

Why is the pain of acute appendicitis characterized as such

A

There are no somatic pain fibers within the appendix, hence pain is due to visceral inflammation from a distended appendix

31
Q

Why is the pain of acute appendicitis localized to the RLQ in the next 12-24 hours

A

Involvement of the adjacent peritoneal surfaces, which has somatic pain fibers

32
Q

In 50% of the population, the appendix is located in a ___ position

A

Retrocecal

33
Q

T/F Nausea and vomiting usually precedes abdominal pain in acute appendicitis

A

F, it usually follows the onset of abdominal pain

34
Q

T/F Anorexia is a classic and consistent finding in acute appendicitis

A

T

35
Q

T/F Symptoms of acute appendicitis includes diarrhea and urinary symptoms

A

T, particularly in cases of perforated appendicitis; may be misdiagnosed as AGE

36
Q

T/F Appendicitis is often associated with constipation

A

T, due to adynamic ileus

37
Q

Pain of appendicitis vs AGE

A

Constant (not cramping or relieved by defecation)

38
Q

Emesis of appendicitis vs AGE

A

Bile-stained and persistent

39
Q

Clinical course of appendicitis vs AGE

A

Worsens readily rather than demonstrating a waxing and waning pattern

40
Q

T/F Fever of acute appendicitis is typically high-grade

A

F, typically low-grade unless perforation has occurred

41
Q

T/F Fever is uncommon in acute appendicitis in children

A

F, it is common

42
Q

The temporal progression fo symptoms of appendicitis occurs slowly

A

F, rapidly, in 24-48 hours

43
Q

Perforation rate of acute appendicitis

A

> 65%

44
Q

T/F Following perforation is a period of less pain and acute symptoms

A

T, presumably with the elimination of pressure within the appendix

45
Q

T/F If the omentum or adjacent intestine is able to wall off the infectious process, the evolution of illness is less predictable and delay in presentation is likely.

A

T

46
Q

When several days have elapsed in the progression of appendicitis, patients often develop signs and symptoms of ___

A

Small bowel obstruction

47
Q

If the appendix is at this position, appendicitis predictably evolves more slowly and patients are likely to relate 4-5 days of illness preceding evaluation.

A

Retrocecal

48
Q

Appendicitis can mimic the symptoms of ___ and ___ if the appendix is retrocecal

A

1) Septic arthritis of the hip 2) Psoas muscle abscess

49
Q

Hallmark of diagnosing acute appendicitis

A

Careful and thorough history and physical examination

50
Q

T/F In many children, appendicitis can be confidently diagnosed based on history and physical examination alone

A

T

51
Q

T/F Children with acute appendicitis rarely present

A

T

52
Q

Typical appearance of children with early (18-36 hours) appendicitis

A

Mildly ill, move tentatively, hunched forward and, often, with a slight limp favoring the right side

53
Q

Supine, children with appendicitis often lie quietly on their ___ side with their knees pulled

A

Right

54
Q

Early appendicitis on auscultation

A

Normal or hyperactive bowel sounds

55
Q

As appendicitis progresses to perforation, auscultation reveals

A

Hypoactive bowel sounds

56
Q

T/F The judicious use of morphine analgesia to relieve abdominal pain does not change diagnostic accuracy or interfere with surgical decision making

A

T

57
Q

The single most reliable finding in the diagnosis of acute appendicitis

A

Localized abdominal tenderness

58
Q

McBurney described the classic point of localized tenderness in acute appendicitis, which is at the

A

Junction of the lateral and middle thirds of the line joining the right anterior–superior iliac spine and the umbilicus on the right

59
Q

When the appendix is at this position, the tenderness on abdominal examination may be minimal and best appreciated on rectal examination

A

Appendix localized entirely in the pelvis

60
Q

In acute appendicitis, the examination is best initiated in which region of the abdomen

A

LLQ

61
Q

In acute appendicitis, abdominal examination is ideally conducted in what direction

A

Counterclockwise

62
Q

Sign of appendicitis exhibited by abdominal pain when coughing

A

Dunphy sign

63
Q

“Guarding” in acute appendicitis refers to

A

Voluntary or involuntary rigidity of the overlying rectus muscle

64
Q

Sign of appendicitis exhibited by referred tenderness

A

Rovsing sign

65
Q

Recommended way to test for rebound tenderness

A

Gentle finger percussion; deep palpation followed by sudden release is very painful and has demonstrated poor correlation with peritonitis; DRE is uncomfortable

66
Q

Psoas sign

A

Pain with active right thigh flexion or passive extension of the hip

67
Q

The sign of appendicitis that is typically positive in cases of retrocecal appendix

A

Psoas sign

68
Q

Obturator sign

A

Adductor pain after internal rotation of the flexed thigh

69
Q

The sign of appendicitis that is typically positive in cases of pelvic appendix

A

Obturator sign

Nelson - The Digestive System (24 decks)

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