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35 Cards in this Set
- Front
- Back
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1. Imaging for suspected appendicitis?
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a. CT abd and pelvis.
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2. How is of acute appendicitis frequently made?
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a. On the basis of clinical hx, physical findings, and lab data.
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3. Note: When a pt presents w/an atypical hx, atypical physical and/or lab findings, it is important to determine whether the atypical presentation is related to another disease process or to atypical positioning of the diseased appendix.
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3. Note: When a pt presents w/an atypical hx, atypical physical and/or lab findings, it is important to determine whether the atypical presentation is related to another disease process or to atypical positioning of the diseased appendix.
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4. Further diagnostic options for an “atypical pt” include?
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a. CT scan
b. U/S. c. Clinical observation w/serial lab evaluations d. Diagnostic lap. |
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5. When is diagnostic lap indicated?
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a. Mainly for pts w/non-specific clinical or radiographic evidence of inflammation or pathology that cannot be further delineated by additional imaging studies.
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6. Advantages of CT?
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a. Identifies appendicitis changes or other pathology (~95% accuracy).
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7. Disadvantages of CT?
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a. Limited sensitivity for early appendicitis and pelvic pathology
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8. Recommended use of CT?
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a. Inflammatory process not related to pelvic pathology
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9. Advantages of U/S?
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a. Greater sens and spec for gynaecologic pathology than CT.
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10. Disadvantages of U/S?
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a. Limited by body habitus
b. Appendicitis signs less well defined. |
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11. Recommended use of U/S?
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a. Suspected gynaecologic pathology.
b. Young children. |
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12. Advantages of Clinical observation w/serial lab studies?
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a. Allows the natural hx of disease evolution.
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13. Disadvantages of Clinical observation w/serial lab studies?
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a. Limited application if localized pain, fever, and leukocytosis are already present.
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14. Recommended use of Clinical observation w/serial lab studies?
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a. Possible early appendicitis and w/o localized signs.
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15. Advantages of Diagnostic laparoscopy?
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a. Allows accurate assessment of pathology.
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16. Disadvantages of Diagnostic laparoscopy?
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a. Invasive
b. Some morbidities. |
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17. Recommended use of Diagnostic laparoscopy?
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a. Inflammatory
b. Pathology of uncertain source. |
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18. Chronic recurrent appendicitis?
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a. Occurs in 5% of pts w/appendicitis and may result from abx administration in pts w/early acute appendicitis.
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19. What is a Interval Appendectomy?
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a. The pt is treated initially w/broad-spectrum abx therapy and CT-guided drainage of the abscess to resolve the infectious process, followed by appendectomy after several weeks.
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20. Utility of Interval Appendectomy?
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a. Generally used for tx of appendicitis complicated by abscess or phlegmon.
b. Since some pts w/appropriate non-operative tx do not develop appendicitis recurrences, the role of interval appendectomy remains unclear. |
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21. Mesenteric Adenitis?
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a. An inflammatory condition occurring w/a viral illness, resulting in painful lymphadenopathy in the small bowel mesentery.
b. This process can be associated w/RLQ pain and tenderness. |
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22. In whom is mesenteric adenitis especially common?
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a. Children.
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23. From what does the appendix arise?
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a. Cecal diverticulum.
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24. Pathogenesis of Appendicitis?
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a. Generally begins with 1 of the following:
1. luminal obstruction by a fecalith 2. Lymphoid hyperplasia 3. Food matter b. When unabated, this process leads to ischaemic necrosis and perforation. |
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25. Classic history of appendicitis?!?
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a. Begins with Vague pain in the periumbilical region, N/V, and the urge to shit.
b. These sx are followed by localization of the pain in the RLQ associated w/local peritonitis. |
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26. How soon after onset of pain do 20% of pts w/appendicitis experience perforation?
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a. 24 hours.
b. Note: Recognition of appendicitis can be delayed bc of atypical presentations caused by retrocolic or pelvic locations. c. Similarly, abx administration during the early course of appendicitis may alter the clinical course. |
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27. What % of pts w/acute appendicitis show a classic presentation?
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a. 50%.
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28. Clinical S/S of Luminal obstruction?
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a. Poorly localized periumbilical pain
b. N/V c. Urge to defecate |
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29. Clinical S/S of abdominal inflammation?
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a. Location of pain depending on the position of the appendix
b. Peritonitis is present only if the inflamed appendix or inflammatory changes involve the peritoneum. |
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30. Clinical S/S of appendiceal Perforation?
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a. Transient improvement in pain but an increase in systemic toxicity.
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30. Clinical S/S of appendiceal Perforation?
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a. Transient improvement in pain but an increase in systemic toxicity.
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31. Most accurate test to assess for acute pelvic inflammatory disease?
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a. Laparoscopy (An erythematous tube w/purulent drainage from the fimbria) and to visualize the appendix.
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32. Best modality to assess pelvic pathology?
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a. Ultrasound.
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33. Best way to assess non-gynaecologic abdominal processes?
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a. CT.
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34. Complete
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34. Complete
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