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Surgery Lectures > Lower GI surgery > Flashcards

Lower GI surgery Flashcards

Disease 1

1
Q

Definition of Acute Appendicitis?

A

Inflammation of the appendix ( the Verniform)

A small pouch that is connected to the Large Intestine.

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2
Q

Which age group is acute appendicitis more common in?

A

Common in adults and young adults between the age ( 10-30 yrs old)

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3
Q

What are the RF of Acute Appendicitis ?

A

Age
Male
Family History

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4
Q

What is the pathophysiology of inflammation of the appendix?

Appendiceal obstruction of the lumen leads to increased intraluminal

A

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

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5
Q

What is the clinical presentation of Acute Appendicitis?

A

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

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6
Q

Does symptoms vary in acute appendicitis?

A

Symptoms may vary depending on
the location of the inflamed
appendix

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7
Q

What is the physical exam for acute appendicitis ?

A

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

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8
Q

What are the investigations of Acute appendicitis ?

A

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

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9
Q

What is the management of acute appendicitis?

A

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

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10
Q

What are the supportive measures for acute appendicitis?

A

If perforated appendix, pt should take the following and risk of sepsis,

-Fluid hydration
-Pain relief
-IV abx

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11
Q

Define Diverticulosis ?

A

The presence of diverticula without symptoms

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12
Q

Define Diverticular disease?

A

The presence of diverticula with mild abdo pain or tenderness and no systemic symptoms.

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13
Q

Define Diverticulitis?

A

Diverticula associated with inflammation and infection

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14
Q

Define acute diverticulitis ?

A

sudden inflammation or
infection associated with diverticula

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15
Q

Define Complicated acute diverticulitis?

A

presence of
complications associated with inflamed or infected
diverticula.

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16
Q

What is the pathophysiology of Diverticulitis ?

A

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.

17
Q

What is the clinical Presentation of Diverticulosis and Diverticular disease?

A

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

18
Q

What is the clinical presentation of acute diverticulitis ?

A

sudden
inflammation or infection associated
with diverticula.

19
Q

What are the symptoms of Acute diverticulitis ?

A

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

20
Q

What are the complicated clinical presentation of acute diverticulitis ?

A

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

21
Q

What is the investigation of acute diverticulitis?

A

Endoscopy through flexible sigmoidoscopy/ colonoscopy or CT colonography

Abdo x ray - useful to rule out other similar cases; ie. intestinal obstruction

22
Q

What is the investigation of complicated acute diverticulitis ?

A

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
23
Q

What is the management of Diverticulosis?

A

No treatment is needed, a balanced diet, increased fluid intake, consider bulk-forming laxatives if constipated, do exercise & stop smoking

24
Q

What is the management of Diverticular disease?

A
  • 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

25
Q

What is the management for complicated acute diverticulitis?

A

If pt is systemically well but has acute diverticulitis

  • Consider not giving antibiotics
  • Offer Paracetamol for pain
  • Advise patient to return if the condition persists

If the patient is systemically unwell, immunosuppressed of has significant co-morbidities, and has Acute diverticulitis

  • Give antibiotics (oral antibiotics for no complications; IV antibiotics for
    complicated cases; review after 48 hours; watch out for sepsis)
  • For patients with uncomplicated acute diverticulitis (CT confirmed), review
    need for antibiotics & discharge if warranted
26
Q

What if Pt has recurrent attacks of diverticulitis ?

A

Consider surgical treatment

27
Q

What is the management of complicated acute diverticulitis ?

A

Abscess formation:
* IV antibiotics & follow guidelines for sepsis
* Do imaging (CT, MRI, ultrasound)
* Consider percutaneous drainage (culture & sensitivity for the abscess)
* Monitor for improvement/deterioration and management appropriately

28
Q

What is the management of complicated acute diverticulitis with Bowel Perforation ?

A

Surgery (laparoscopic or open)
* Do extensive lavage if with fecal peritonitis
* Decide if can do primary anastomosis or damage control surgery
(Hartman’s procedure

Surgery Lectures (12 decks)

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