RIF pain - surgery Flashcards
T/F
Acute appendicitis is the commonest emergency operation
T
T/F
Acute appendicitis can be diagnosed clinically
F
very difficult to diagnose
need to go in laparascopically to confirm
When is appendicitis happen? What age group
childhood/young adulthood
elderly
males more likely
Pathology appendicitis?
Muccosal inflammation Obstruction Build up mucosa and exudate Perforation Lymphoid hyperplasia
T/F
Peritonitis can be fatal, leads to generalised abdominal pain and guarding. Rigid abdomen
T
Classic picture appendicitis?
Mild pyrexia (never high intially) Mild tachycardia Localised RIF pain Guarding Rebound
Rosving’s Sign
Pressing on the left causes pain on the right
Psoas Sign
Patient keeps the right hip flexed as this lifts an infmaled appendix off the psoas
Obturator Sign
If appendix is touching obturator internus, flexing the hip and internally rotting will cause pain
“special” cases, appendixes anatomic differences?
Retrocaecal appendix: May be very few signs - sits behind caecum
Pelvic appendix: Diarrhoea, urinates a lot
Postileal: Rare, diarrhoea, vomiting - compresses ileum
Differential appendicitis?
Mittelschmerz
Perforated ulcer
Pancreatitis
Rectus sheath haemotoma
Investigation appendicitis?
CLINICAL diagnosis
USS - check swollen appendicitis
AXR to exclude other causes
Bloods (important CRP, WCC) to look for signs infection
Urinalysis rule out other things i.e. bladder infection
Investigative results appendicitis?
MANTRELS Migration pain to RLQ Anorexia Nausea+vomiting Tenderness in RLQ Rebound pain Elevated Temperature Leukocytosis Shift WBC count to left
What is rebound pain?
Pain upon removal of pressure
Management acute appendicitis?
Analgesia Antipyretics Theatre Antibiotics Appendicectomy - Laparascopic (best)
