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9 Cards in this Set
- Front
- Back
MECHANISM: Acute Appendicitis
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Luminal obstruction (Fecaliths; or less commonly gallstones, tumour, mass of worms)
-> Iscahemic injury (vascular compression) + luminal stasis -> Bacterial proliferation -> Inflammation -> Eedema, neutrophilic infiltrate |
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Acute Appendicitis: Pathology
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Early:
Congestion + neutrophilic infiltrate Later: Glistening serosa -> Dull, granular, erythematous Dx: Netrophilic infiltration of muscularis propria |
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Acute Appendicitis: Complications
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Abscesses
Ulceration Ganrenous necrosis -> rupture + suppurative peritonitis |
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Acute Appendicitis: Clinical features
One is a classical finding |
Typical: Periumbilical pain
-> Localises to right lower quadrant Followed by: Nausea & Vomiting Low fever Mildly raised peripheral white cell count Classical finding: McBurney's sign Symptoms/signs often absent |
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Acute Appendicitis: Classical finding
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Classical finding:
McBurney's sign (deep tenderness, 2/3 from umbilicus to right ASIS [McBurney's point]) |
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Acute Appendicitis: Unusual pain referrals
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Retrocaecal appendix can refer pain to flank or back
Malrotated colons can produce pain in unusual areas |
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Acute Appendicitis: Tx
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Appendectomy
Low risk, risk-benefit ratio good |
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Acute Appendicitis: Complications
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Delayed resection of inflamed appendix:
Appendiceal perforation Pyelophlebitis (inflam of veins of renal pelvis) Portal venous thrombosis Liver abscess Bacteraemia |
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Appendiceal tumour: Carcinoid
Clinical presentation |
Carcinoid = Most common tumour of appendix
Usu affects most distal tip of appendix -> solid bulb to 2-3cm diameter *Characteristic yellow colour Metastasis rare |