Lecture 10 Flashcards
what is the most likely cause of RLQ pain?
appendicitis
what are the 3 most likely causes of RLQ pain?
appendicitis
mesenteric lymphadenitis
meckel’s diverticulits
what is the most common general surgical emergency?
appendicitis
what time of year is appendicitis most common?
spring and summer
how long is the appendix?
10cm
what does the base of the appendix join to?
cecum
where is the tip of the appendix usually located?
behind the cecum
where is the appendix located in relation to the ileocecal valve?
posterior and caudad
what artery supplies the appendix?
appendiceal artery –> branch of ileocolic artery
what is located in the submucosa of the appendix?
lymphoid follicles
what mucosal layer of the appendix are lymphoid follicles located?
submucosa
what is the cascade of events leading to appendicitis?
obstruction of lumen due to inspissated stool –> lymphoid hyperplasia –> bacterial overgrowth –> distension w/ vascular compromise - causing visceral pain –> necrosis and irritation of peritoneum
what are symptoms of appendicitis?
loss of appetite nausea vomiting fever tachycardia elevated WBC
how can you differentiate gastroenteritis from appendicitis?
gastroenteritis: vomiting and diarrhea first –> pain later
appendicitis: pain first –> vomiting later
what is Dunphy’s sign?
coughing exacerbates RLQ pain
what is Rovsing’s sing?
pain in RLQ during palpation in LLQ
what is Obturator’s sign?
pain w/ internal rotation of hip
what is McBurney’s point?
point 1/3 distance along a line from the anterior iliac spine to the umbilicus
what will labs show in appendicitis?
elevated WBC
what should you suspect with WBC >20K in appendicitis?
perforation and abscess
what is the gold standard diagnostic test for appendicitis?
CT
what is the test of choice for appendicitis diagnosis in a pregnant woman?
US
what is seen on a CT scan w/ appendicitis?
distended appendix >7mm fecolith circumferential wall thickening and enhancement fat stranding in surrounding tissue free fluid or abscess
what is the treatment for appendicitis?
surgery
antibiotics if using a non-operative approach
how is an open appendectomy performed?
transverse RLQ incision –> muscle splitting incision –> divide, clamp, and tie the mesenteric/appendicular artery as it enters the cecum
how is a laparoscopic appendectomy performed?
3 ports (1 for camera and 2 for working) –> mesentery divided w/ mascular stapler and appendix divided w/ bowel stapler –> remove appendix through one of the ports
when should a patient w/ appendicitis be treated non operatively?
patient w/ acute uncomplicated appendicitis w/ prohibitive operative or anesthesia risk
how do you treat acute uncomplicated appendicitis non operatively?
admit for 23-48hrs observation
IV antibiotics
10 days of at home antibiotics follow up in clinic
are longer patient delays or hospital delays associated with a worsening grade of appendicitis?
patient delays
the risk of appendix rupture is very low during what time frame?
<35hrs from symptom onset
what is the treatment for ruptured appendicitis?
admit fluids foley antibiotics drain abscess
what is the preferred method of drainage for a ruptured appendix?
percutaneous
where do the lymph nodes involved in mesenteric lymphadenitis drain to?
ileo-cecal region
how do affected nodes appear in mesenteric lymphadenitis?
enlarges
discrete
soft
pink
what histological changes are seen in mesenteric lymphadenitis?
reactive hyperplasia
mesenteric lymphadenitis is often preceded by what?
recent illness
what is the first symptom of mesenteric lymphadenitis?
pain
where is pain due to mesenteric lymphadenitis located?
RLQ
what is the most common true diverticulum of the GI tract?
Meckel’s diverticulum
how does Meckel’s diverticulum present?
blood in stool due to ulceration
bowel obstruction symptoms
