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15 Cards in this Set
- Front
- Back
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Explain the pathogenesis of appendicitis
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Children or young adults - hyperplasia of lymphoid follicles, initiated by infection
Adult: fibrosis/stricture, fecolith, obstructing neoplasm --> luminal obstruction --> bacterial overgrowth --> inflammation/swelling --> increased pressure --> localised ischaemia --> gangrene/perforation --> localised abscess or peritonitis |
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Symptoms of appendicitis?
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abdominal pain THEN anorexia, N/V
pain initially periumbilical, constant, dull, poorly localised, then well localised pain over McBurney's point (due to progession of visceral irritation to parietal irritation) Atypical presentations = RUQ pain from a long appendix or a right loin pain from a retrocaecal appendix Moderate fever, tachycardia |
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What is McBurney's sign?
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Tenderness 1/3 from anterior suprior iliac spine to umbilicus
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What is Rovsing's sign?
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Palpation pressure to left abdomen causes McBurney's point tenderness
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How do you tell if it is a retrocecal appendix or a pelvic appendix?
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Retrocecal - psoas sign (pain on flexion of hip against resistance or passive hyperextension of hip)
Pelvic appendix: obturator sign (flexion then external or internal rotation about right hip causes pain) |
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Complications associated with appendicitis?
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perforation (esp if > 24 hours)
Periappendiceal abscess with or without perforation (most common) subphrenic abscess (persistent fever post op) Phlegmon Pyelophlebitis - infection of the portal vein - may lead to thrombosis (radiology - gas in portal vein) |
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What is the sensitivity and specificity of US for detecting appendicitis?
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Sensitivity 75%, specificity 90%
Most useful to exclude ovacian cysts, ectopic pregnancy or tuboovarian abscess |
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What is the best investigation to order if appendicitis is suspected?
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CT scan - overall accuracy 94-100%
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What is mesenteric adenitis?
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Clinical features to appendicitis but appendix is normal and there are several enlarged lymph nodes in the mesentery of the terminal ileum
Cause is obscure but self limiting with spontaneous improvement over 24-36 hours |
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Management of appendicitis?
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Hydrate, correct electrolyte abnormalities
Surgery + antibiotic coverage (don't give if diagnosis in question - will mask perforation) If localised abscess consider radiologic draininage + antibiotics + inverval appendectomy in 6 weeks because there is a risk of recurrent sepsis |
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What is meckel's diverticulum?
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congenital condition = remnant of the embyronic vitelline duct
has several types of mucosa (gastric, pancreatic colonic) Present in 2% of population, within 2 feet of ileocaecal valve |
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Symptoms of meckel's diverticulum?
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2% symptomatic
GI bleed, SBO, diverticulitis Painless bleeding - ulceration caused by ectopic gastric mucosa |
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Complications associated with meckel's diverticulum?
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fistula
Fibrous cord between umbilicu sand ileum SBO due to volvulues, intussusception, perforation |
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Does absence of leukocytosis rule out appendicitis?
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NO
Leukocytosis > 20 suggests probably perforation |
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Does absence of leukocytosis rule out appendicitis?
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NO
Leukocytosis > 20 suggests probably perforation |
