Diseases of Small Bowel and Appendix Flashcards
(41 cards)
incidence of appendicitis
rare in infancy
peaks in childhood and young adults
peaks again in elderly
aetiology of appendicitis
obstruction of lumen with faecolith
bacterial
viral
parasites
pathology of appendicitis
lumen may or may not be occluded mucosal inflammation lymphoid hyperplasia obstruction build up of mucus and exudate venous obstruction ischaemia - bacterial invasion through wall perforation small bowel adheres phlegmonous mass peritonits
symptoms of appendicitis
anorexia
nausea +/- vomiting
rectal tenderness
+/- fever
signs of appendicitis
mild Pyrexia mild tachycardia central abdominal pain, later localised pain in right iliac fossa guarding rebound rosving's psoas obturator
rosving’s sign
pressing on the left causes pain on the right
psoas sign
patient keep the right hip flexed as this lefts an inflamed appendix off the posts
obturator signs
if appendix is touching obturator internus, flexing the hip and internally rotating with cause pain
special cases of appendicitis
retrocacal appendix pelvic appendix postileal the obese the elderly children pregnancy
retrocaecal appendix
may be very few signs
pelvic appendix
diarrhoea
frequency of micturition
postilieal apendicitis
rare
diarrhoea
vomiting
differential diagnosis of appendicitis in children
Gastroenteritis Mesenteric adenitis Meckel’s diverticulum Intususseption Henoch-Schonlein Purpura Lobar pneumonia
differential diagnosis of appendicitis in adults
Terminal ileitis Ureteric colic Acute pyelonephritis Perforated ulcer Pancreatitis Rectus sheath haemotoma
differential diagnosis of appendicitis in the elderly
Sigmoid diverticulitis
Intestinal obstruction
Carcinoma of the caecum
differential diagnosis of appendicitis in woman
Mittelschmerz
Ovarian cyst
Salpingitis
Ectopic pregnancy
rare differential diagnosis of appendicitis
Pophyria
Diabetic ketoacidosis
typhilitis
tests for appendicitis
it is a clinical diagnosis; ultrasound - first line AXR - exclude other causes FBC urinalysis Alvarado score
describe the Alvarado score
MANTRELS; migration of pain to lower right quadrant anorexia nausea and vomiting tenderness in right lower quadrant rebound pain elevated temperature leukocytosis shift of white blood cell count to left
management of appendicitis
analgesia (pain)
antipyretics (reduce fever)
appendicectomy
antibiotics
treatment of an appendix mass
antibiotics - first line
can choose whether or not to operate
complications of surgical intervention of appendicitis
tachycardia
worsening pain
increase in pain
vomiting or copious NG aspirates (ileus)
describe an appendix abscess
not an appendix mass
usually has liquidised
usually delayed
treatment of appendix abscess
radiological drains