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CM - Gastro Block 5 > Lecture 10 > Flashcards

Lecture 10 Flashcards

1
Q

what is the most likely cause of RLQ pain?

A

appendicitis

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2
Q

what are the 3 most likely causes of RLQ pain?

A

appendicitis
mesenteric lymphadenitis
meckel’s diverticulits

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3
Q

what is the most common general surgical emergency?

A

appendicitis

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4
Q

what time of year is appendicitis most common?

A

spring and summer

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5
Q

how long is the appendix?

A

10cm

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6
Q

what does the base of the appendix join to?

A

cecum

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7
Q

where is the tip of the appendix usually located?

A

behind the cecum

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8
Q

where is the appendix located in relation to the ileocecal valve?

A

posterior and caudad

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9
Q

what artery supplies the appendix?

A

appendiceal artery –> branch of ileocolic artery

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10
Q

what is located in the submucosa of the appendix?

A

lymphoid follicles

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11
Q

what mucosal layer of the appendix are lymphoid follicles located?

A

submucosa

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12
Q

what is the cascade of events leading to appendicitis?

A

obstruction of lumen due to inspissated stool –> lymphoid hyperplasia –> bacterial overgrowth –> distension w/ vascular compromise - causing visceral pain –> necrosis and irritation of peritoneum

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13
Q

what are symptoms of appendicitis?

A 
loss of appetite
nausea
vomiting
fever
tachycardia
elevated WBC
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14
Q

how can you differentiate gastroenteritis from appendicitis?

A

gastroenteritis: vomiting and diarrhea first –> pain later
appendicitis: pain first –> vomiting later

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15
Q

what is Dunphy’s sign?

A

coughing exacerbates RLQ pain

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16
Q

what is Rovsing’s sing?

A

pain in RLQ during palpation in LLQ

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17
Q

what is Obturator’s sign?

A

pain w/ internal rotation of hip

18
Q

what is McBurney’s point?

A

point 1/3 distance along a line from the anterior iliac spine to the umbilicus

19
Q

what will labs show in appendicitis?

A

elevated WBC

20
Q

what should you suspect with WBC >20K in appendicitis?

A

perforation and abscess

21
Q

what is the gold standard diagnostic test for appendicitis?

A

CT

22
Q

what is the test of choice for appendicitis diagnosis in a pregnant woman?

A

US

23
Q

what is seen on a CT scan w/ appendicitis?

A 
distended appendix >7mm
fecolith
circumferential wall thickening and enhancement
fat stranding in surrounding tissue
free fluid or abscess
24
Q

what is the treatment for appendicitis?

A

surgery

antibiotics if using a non-operative approach

25
Q

how is an open appendectomy performed?

A

transverse RLQ incision –> muscle splitting incision –> divide, clamp, and tie the mesenteric/appendicular artery as it enters the cecum

26
Q

how is a laparoscopic appendectomy performed?

A

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

27
Q

when should a patient w/ appendicitis be treated non operatively?

A

patient w/ acute uncomplicated appendicitis w/ prohibitive operative or anesthesia risk

28
Q

how do you treat acute uncomplicated appendicitis non operatively?

A

admit for 23-48hrs observation
IV antibiotics
10 days of at home antibiotics follow up in clinic

29
Q

are longer patient delays or hospital delays associated with a worsening grade of appendicitis?

A

patient delays

30
Q

the risk of appendix rupture is very low during what time frame?

A

<35hrs from symptom onset

31
Q

what is the treatment for ruptured appendicitis?

A 
admit
fluids
foley
antibiotics
drain abscess
32
Q

what is the preferred method of drainage for a ruptured appendix?

A

percutaneous

33
Q

where do the lymph nodes involved in mesenteric lymphadenitis drain to?

A

ileo-cecal region

34
Q

how do affected nodes appear in mesenteric lymphadenitis?

A

enlarges
discrete
soft
pink

35
Q

what histological changes are seen in mesenteric lymphadenitis?

A

reactive hyperplasia

36
Q

mesenteric lymphadenitis is often preceded by what?

A

recent illness

37
Q

what is the first symptom of mesenteric lymphadenitis?

A

pain

38
Q

where is pain due to mesenteric lymphadenitis located?

A

RLQ

39
Q

what is the most common true diverticulum of the GI tract?

A

Meckel’s diverticulum

40
Q

how does Meckel’s diverticulum present?

A

blood in stool due to ulceration

bowel obstruction symptoms

CM - Gastro Block 5 (3 decks)

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