Small bowel and Appendix Flashcards
what position are most appendicitis
retrocaecal
when does an appendicitis usually happen
childhood/ young adulthood
what can cause an appendicits
obstruction of the lumen with faecolith, bacterial, viral, parasites
what is the pathology of an appendicitis
Lumen may or may not be occluded Mucosal inflammation Lymphoid hyperplasia Obstruction Build up of mucus and exudate Venous obstruction Ischaemia..bacterial invasion through wall Perforation
what is hyperplasia
the enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells
Presence of inflammation in abdomen brings the greater omentum
Small bowel adheres
Phlegmonous mass
Peritonitis can be fatal
what are the symptoms of appendicitis
Central pain that migrates to RIF Anorexia Nausea One or two vomits May not have moved bowels Pelvic: vaguer pain localisation: rectal tenderness
what are the clinical signs of appendicitis
mild pyrexia, mild tachycardia, localised pain in RIF, guarding, rebound
what is rosving’s sign
pressing on the left causes pain on the right- seen in appendicitis
what is psoas sign
patient keep the right hip flexed as this lifts an inflamed appendix off the psoas
what is the psoas
The psoas is a deep-seated core muscle connecting the lumbar vertebrae to the femur
what is the obturator sign
if appendix is touching the obturator internus, flexing the hip and internally rotating will cause pain
what might be seen in pelvic appendicitis
diarrhoea, frequency of micturition (passing urine)
what might be seen in postileal appendicitis
rare- diarrhoea and vomitting
what might be seen in retrocaecal appendicitis
might have very few signs
what can be the differential diagnosis of appendicitis in children
Gastroenteritis Mesenteric adenitis Meckel’s diverticulum Intususseption Henoch-Schonlein Purpura Lobar pneumonia
what are the differential diagnosis of appendicitis in adults
Terminal ileitis Ureteric colic Acute pyelonephritis Perforated ulcer Pancreatitis Rectus sheath haemotoma
what are the differential diagnosis of appendicitis in women
Mittelschmerz
Ovarian cyst
Salpingitis
Ectopic pregnancy
what are the differential diagnosis of appendicitis in the elderly
Sigmoid diverticulitis
Intestinal obstruction
Carcinoma of the caecum
when is USS useful in appendicitis
in women and kids
what investigations are useful in appendicitis
USS useful in women and kids
AXR to exclude other causes
Bloods (important CRP, WCC)
Urinalysis
what score in used to calculate likelihood of appendicitis
alvarado- movement of pain, anorexia, nausea and vomiting, tenderness in RUQ, rebound, high temp, leukocytosis, sore to move/ cough/ laugh, flushed red face, foetor oris (bad smell)
whats is the management for appendicitis
analgesia, antipyretics, theatre, antibiotics, appendicetomy (laparoscopic best)
what is the treatment for an appendix mass
antiobiotics first line- as long as you exclude carcinoma, theatre if fails or complicated (tachycardia, worsening pain, increase in size, vomiting)
what is an appendix abscess
not an appendix mass- usually delayed and has liquidised
how is an appendix abscess treated
radiological drain
what are the complications of appendix abscess
Pelvic abscess Wound infection Intra-abdominal abscess Ileus Respiratory DVT/PE Portal pyaemia Faecal fistula Adhesions Right sided inguinal hernia
what will have to be replaced if the small bowel is removed
B12 and folate as that is where it is absorbed
what are the symptoms of small bowel obstruction
pain (colicky, central), absolute constipation, vomiting, burping, abdo distention
what can cause small bowel obsbtruction
within the lumen:
-gallstone, food, bezoar
within the wall:
-tumour, crohns, radiation
outside the wall:
-adhesions, herniation
what is the typical presentation of small bowel obstruction
distention, vomiting, borborygmi (rumbling or gurgling), pain, faeculent vomiting, presence of a cause
what investigations should be done into small bowel obstruction
urinalysis, bloods, gases to asses state of patient
AXR, contrast CT, gastrograffin studies to confirm diagnosis
what is the drip and suck management of small bowel obstruction
conservative management
- ABC
- analgesia
- fluids with potassium
- catheterise
- NG tube
- antithromboembolism measures
do this for up to 72 hours
intervene earlier if strangulation, perforation, ischaemia
what are the types of mesenteric ischaemia
embolus (thrombosis),
chronic (SMA, cramps, like ischaemia of the guts, atherosclerosis),
acute
what can cause mesenteric ischaemia
embolus usually from AFib (forms in LA, sticks in narrow SMA)
virchows triad- dehydrates, hypercoagulable, compression, vasoconstricting drugs
what are the blood gases like in mesenteric ischaemia
acidosis, lactate elevated, WCC may by high
what is the management for mesenteric ischaemia
prepare for the worst
if non viable resect, re-anastomse/ staple
if viable (rare) SMA embolectomy
what can cause a small bowel haemorrhage
vascular malformations, ulcerations
what are the complications of meckels diverticulum
bleed, ulcerate, obstruction, malignant change
what is meckles diverticulum
congenital abnormalities of the small intestine
