Disease of the Small Bowel & Appendix Flashcards
Who usually gets appendicitis?
- Usually childhood/young adulthood
- Another peak in the elderly
- Rare in infancy
M:F ratio 3:2 before 25 years, then equal
What are the possible causes of appendicitis?
- Unknown cause
- Obstruction of the lumen with faecolith
- Bacterial
- Viral (clustering of cases)
- Parasites
Describe the macroscopic appearance of the appendix in appendicitis
- Lumen may or may not be occluded
- Mucosal inflammation
- Lymphoid hyperplasia
- Build up of mucus and exudate
- Venous obstruction
- Ischaemia..bacterial invasion through wall
- Perforation
In what groups is peritonitis most likely fatal?
Increased Age
Immunosuppressed
Diabetes
Absence of omentum (previous surgery)
What signs are classically seen in a patient presenting with appendicitis?
- Mild pyrexia (never high temp initially)
- Mild tachycardia
- Localised pain in RIF
- Guarding
- Rebound
What specific signs can you illicit to aid a diagnosis of appendicitis?
- Rosving’s
=> Pressing on the left causes pain on the right - Psoas
Pt keeps right hip flexed as this lifts an inflamed appendix off the psoas muscle - Obturator
If appendix is touching obturator internus, flexing the hip and internally rotating will cause pain - Pointing
Where did it start, where it is now?
=> Diffuse RIF -> McBurney’s Point
An appendix in the retrocaecal position may show very few signs of appendicitis. TRUE/FALSE?
TRUE
A pelvic appendix may cause what symptoms?
diarrhoea
increased frequency of micurition
What differential diagnoses must you consider in children who present with symptoms similar to that of appendicitis?
- Gastroenteritis
- Mesenteric adenitis
- Meckel’s diverticulum
- Intususseption
- Henoch-Schonlein Purpura
- Lobar pneumonia
What differentials for appendicitis are more common in adults?
- Terminal ileitis
- Ureteric colic
- Acute pyelonephritis
- Perforated ulcer
- Pancreatitis
- Rectus sheath haemotoma
If a women presents with symptoms typucal of appendicitis, what other differentials should you consider?
Mittelschmerz
Ovarian cyst
Salpingitis
Ectopic pregnancy*
What differential diagnoses of appendicitis should be considered in the elderly?
- Sigmoid diverticulitis
- Intestinal obstruction
- Carcinoma of the caecum
What investigations can be used in the diagnosis of appendicitis?
- USUALLY A CLINICAL DIAGNOSIS
- USS useful in women and kids
- AXR to exclude other causes
- Bloods (important CRP, WCC)
- Urinalysis
How is appendicitis managed?
- Analgesia
- Antipyretics
- Theatre (laparoscopic appendicectomy)
- Antibiotics
An appendix abscess usually presents as a mass. TRUE/FALSE?
FALSE
- usually delayed
- liquified by this point
- needs radiological drainage
What are the potential complications of appendicitis?
- Pelvic/intra-abdominal abscess
- Wound infection
- Ileus
- DVT/PE
- Faecal fistula
- Adhesions
- Right sided inguinal hernia
Describe how Carcinoid of the appendix is treated with surgery depending on its size.
If < 1cm = appendicectomy alone
> 2cm completion right hemicolectomy
A small bowel obstruction causes what symptoms?
Pain (colicky, central) Absolute constipation Vomiting (may be faeculent) Burping Abdominal distension
What can cause a small bowel obstruction?
Within the lumen (gallstone, food, bezoar)
Within the wall (tumour, Crohn’s, Radiation)
Outside the wall (Adhesions, Herniation)
If you suspect a small bowel obstruction you must look for the cause. TRUE/FALSE?
TRUE
How does a small bowel obstruction look on an AXR?
- large distended loops of bowel
=> filled with gas
HOw is small bowel obstruction treated?
- ABC
- Analgesia
- Fluids with Potassium
- They are usually hypokalaemic and alkalotic
- Catheterise
- NG tube (Ryles tube NOT feeding tube)
- Anticoagulation measures
How long can you use drip and suck?
- Up to 72 hours is standard Intervene earlier if: - Strangulation - Perforation - Ischaemia
HOw is small bowel obstruction managed surgically?
- Laparotomy (midline incision)
- Find obstruction by following collapsed or dilated bowel
Remember to give:
- Antibiotics
- Anticoagulation
