Lower GI surgery Flashcards
Disease 1
Definition of Acute Appendicitis?
Inflammation of the appendix ( the Verniform)
A small pouch that is connected to the Large Intestine.
Which age group is acute appendicitis more common in?
Common in adults and young adults between the age ( 10-30 yrs old)
What are the RF of Acute Appendicitis ?
Age
Male
Family History
What is the pathophysiology of inflammation of the appendix?
Appendiceal obstruction of the lumen leads to increased intraluminal
The blind segment is situated at the base of the caecal.
It has a small lumen so it is pre-disposed to everything.
It can lead to ischemia and gangerene
What is the clinical presentation of Acute Appendicitis?
Abdo pain- shift of the pain from periumbilical radiate to the right lower quadrant area
Nausea, vomiting follow the onset of pain
Fever related symptoms occur later in the course of the illness
Does symptoms vary in acute appendicitis?
Symptoms may vary depending on
the location of the inflamed
appendix
What is the physical exam for acute appendicitis ?
Abdo exam
Assess for Mc Burney’s point tenderness; rebound
tenderness
Rovsing’s, psoas, obturator signs
When you press on the right side, the pt would feel really painful
What are the investigations of Acute appendicitis ?
Bloods such as Full blood count, ESR/CRP- Elevation of leukocytes, neutrophils
Urinalysis
Ask about last menstrual period - to evict Ecoptic pregnancy ( for the women with child bearing age)
Imaging ( ESP IN EPIVOCAL CASES)
-CT of the abdomen and pelvis
-Ultrasound of the right iliac fossa for further evaluation
What is the management of acute appendicitis?
Surgery (appendicectomy)
-Laparoscopic approach
or
-open approach
Easy to do the surgery if there is no perforation, with perforated appendix the surgery will be difficult
What are the supportive measures for acute appendicitis?
If perforated appendix, pt should take the following and risk of sepsis,
-Fluid hydration
-Pain relief
-IV abx
Define Diverticulosis ?
The presence of diverticula without symptoms
Define Diverticular disease?
The presence of diverticula with mild abdo pain or tenderness and no systemic symptoms.
Define Diverticulitis?
Diverticula associated with inflammation and infection
Define acute diverticulitis ?
sudden inflammation or
infection associated with diverticula
Define Complicated acute diverticulitis?
presence of
complications associated with inflamed or infected
diverticula.
What is the pathophysiology of Diverticulitis ?
Obstruction and trauma to a diverticulum ischemia, micro
perforation, and infection.
Inspissated food particles cause erosion of the diverticular wall
inflammation focal necrosis, and perforation.
Diet, lifestyle and genetics alter the mucosal barrier and immune
function mucosal inflammation.
What is the clinical Presentation of Diverticulosis and Diverticular disease?
Diverticulosis: asymptomatic; may present
with lower GI bleed without abdominal
pain
Diverticular disease: intermittent pain at
the left lower quadrant of the abdomen
- Constipation and diarrhea
Occasional large rectal bleeds are often described as bright red bleeding
( hematochezia)
Presentation may be similar with the IBS, colitis and malignancy
What is the clinical presentation of acute diverticulitis ?
sudden
inflammation or infection associated
with diverticula.
What are the symptoms of Acute diverticulitis ?
constant abdominal
pain, usually severe and localising in
the left lower quadrant.
* Other features, including fever, may
also be present.
* Tends to develop complications
complicated acute diverticulitis
What are the complicated clinical presentation of acute diverticulitis ?
presence of complications associated with inflamed or infected diverticula
Rigid abdomen & guarding perforation peritonitis
* Tender mass in the left lower abdomen is suggestive of
a phlegmon or abscess
* Abdominal distention & inability to pass flatus bowel
obstruction
* Presence of fecaluria, pneumaturia bladder/vaginal fistula
What is the investigation of acute diverticulitis?
Endoscopy through flexible sigmoidoscopy/ colonoscopy or CT colonography
Abdo x ray - useful to rule out other similar cases; ie. intestinal obstruction
What is the investigation of complicated acute diverticulitis ?
CT scan ( contrast /non-contrast) to see the overall pic of the abdomen
Can aid in draining abscesses via a percutaneous CT guided approach
- Alternative imaging modalities: MRI, ultrasound
- Others: FBC, U&Es, CRP
What is the management of Diverticulosis?
No treatment is needed, a balanced diet, increased fluid intake, consider bulk-forming laxatives if constipated, do exercise & stop smoking
What is the management of Diverticular disease?
- A balanced diet, increase fluid intake, consider bulk-forming laxatives if constipated, exercise & stop smoking
Paracetamol for pain relief and anti-spasmodic for abdominal cramping
If persistent or no response to treatment, consider other causes and investigate and manage appropriately
