Diseases of Small Bowel and Appendix Flashcards

(41 cards)

1
Q

incidence of appendicitis

A

rare in infancy
peaks in childhood and young adults
peaks again in elderly

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2
Q

aetiology of appendicitis

A

obstruction of lumen with faecolith
bacterial
viral
parasites

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3
Q

pathology of appendicitis

A
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
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4
Q

symptoms of appendicitis

A

anorexia
nausea +/- vomiting
rectal tenderness
+/- fever

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5
Q

signs of appendicitis

A
mild Pyrexia 
mild tachycardia 
central abdominal pain, later localised pain in right iliac fossa 
guarding 
rebound 
rosving's
psoas
obturator
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6
Q

rosving’s sign

A

pressing on the left causes pain on the right

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7
Q

psoas sign

A

patient keep the right hip flexed as this lefts an inflamed appendix off the posts

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8
Q

obturator signs

A

if appendix is touching obturator internus, flexing the hip and internally rotating with cause pain

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9
Q

special cases of appendicitis

A
retrocacal appendix 
pelvic appendix 
postileal
the obese
the elderly
children
pregnancy
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10
Q

retrocaecal appendix

A

may be very few signs

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11
Q

pelvic appendix

A

diarrhoea

frequency of micturition

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12
Q

postilieal apendicitis

A

rare
diarrhoea
vomiting

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13
Q

differential diagnosis of appendicitis in children

A
Gastroenteritis
Mesenteric adenitis
Meckel’s diverticulum
Intususseption
Henoch-Schonlein Purpura
Lobar pneumonia
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14
Q

differential diagnosis of appendicitis in adults

A
Terminal ileitis
Ureteric colic
Acute pyelonephritis
Perforated ulcer
Pancreatitis
Rectus sheath haemotoma
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15
Q

differential diagnosis of appendicitis in the elderly

A

Sigmoid diverticulitis
Intestinal obstruction
Carcinoma of the caecum

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16
Q

differential diagnosis of appendicitis in woman

A

Mittelschmerz
Ovarian cyst
Salpingitis
Ectopic pregnancy

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17
Q

rare differential diagnosis of appendicitis

A

Pophyria
Diabetic ketoacidosis
typhilitis

18
Q

tests for appendicitis

A
it is a clinical diagnosis;
ultrasound - first line
AXR - exclude other causes 
FBC
urinalysis
Alvarado score
19
Q

describe the Alvarado score

A
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
20
Q

management of appendicitis

A

analgesia (pain)
antipyretics (reduce fever)
appendicectomy
antibiotics

21
Q

treatment of an appendix mass

A

antibiotics - first line

can choose whether or not to operate

22
Q

complications of surgical intervention of appendicitis

A

tachycardia
worsening pain
increase in pain
vomiting or copious NG aspirates (ileus)

23
Q

describe an appendix abscess

A

not an appendix mass
usually has liquidised
usually delayed

24
Q

treatment of appendix abscess

A

radiological drains

25
complications of appendix abscess
``` Pelvic abscess Wound infection Intra-abdominal abscess Ileus Respiratory DVT/PE Portal pyaemia Faecal fistula Adhesions Right sided inguinal hernia ```
26
describe carcinoid of the appendix
appears in crypts of Lieberkuhn metastatic risk relates to size stains for chromagrannin
27
obstruction of the small bowel
proximal bowel will dilate and develop altered motility | swells due to build up of fluid and gas
28
where does the gas come from that causes the small bowel to swell
anaerobic and aerobic metabolism that occurs with the overgrowth of organisms in the obstructed bowel - nitrogen and hydrogen sulphide
29
where may the small bowel be obstructed
within the lumen within the wall outside the wall
30
what may cause the lumen of the small bowel to be obstructed
gallstone food bezoar
31
what may cause the inside wall of the small bowel to be obstructed
tumour Crohn's disease radiation
32
what may cause the outside wall of the small bowel to be obstructed
adhesions | herniation
33
symptoms of obstruction of the small bowel
``` look for a cause of obstruction (groins both femoral and inguinal) - scars, hernias pain constipation vomiting burping abdominal distension borborygmi ```
34
tests for obstruction of small bowel
``` urinalysis bloods gases AXR CT gastrograffin studies ```
35
treatment for obstruction of small bowel
``` analgesia fluids + K+ catheterise NG tube (ryles, not feeding) anti-thromboembolism measures ```
36
causes of mesenteric ischaemia
embolus - from AF (forms in left atrium and sticks in narrow Superior mesenteric artery) thrombosis (arterial and venous) - Virchow's triad
37
chronic mesenteric ischaemia
superior mesenteric artery affected cramps 'angina of the gut' atherosclerosis
38
acute mesenteric ischaemia
small bowel usually infarcts - dies | colon lives due to marginal artery
39
presentation of mesenteric ischaemia
pain out of proportion to clinical findings acidosis lactate elevated elevated WBC
40
tests for mesenteric ishcaemia
blood gases | CT angiogram
41
treatment for mesenteric ischaemia
very quick treatment required resect in non-viable re-anastomose or staple and planned return superior mesenteric artery embolectomy