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9 Cards in this Set
- Front
- Back
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defn
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inflammation of appendix
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pathology
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acute inflammation - then secondary infection without obstruction- acute nonobstructive appendicitis
luminal obstruction- mucus and infl fluid collects- ^ pressure- blocked lymphatics and veins- ^oedema* mucosal ulceration and ischemia- bacterial tranlocation- bacterial spread to submucosa and muscularis propria- Acute obs appendicitis thrombosis of artery- ischemic necrosis of wall- gangrene- perforation - peritonitis perforation- loaclisation by greater omentum and dilated ileum- appendicular abscess appendicular mass is formed when localisation occurs without pus inside blockage of lumen-mucus collects-enlargement- mucocele |
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types
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acute nonobstructive
acute obstructive recurrent subacute stump |
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symptoms
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-rare before 2 yrs of age
-MURPHY's triad pain ( initialy umbilcus then RIF) vomiting ( reflex pylorospasm) temperature -constipation or diarrhoea - urinary frequency -fetor oris |
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signs
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- tenderness and rebound tenderness at mc.burney's point- BLUMBERG sign
- ROVSING's sign- on pressing LIF pain in RIF due to shift of bowel loops irritating peritoneum. - COPE's psoas test- hyperextension COPE's obturator test-internal rotation at right hip causes pain in RIF -BALDWIN'S sign- legs lifted off bed in extended position - pain over flanks when pressed -positive in retrocaecal appendix - sherren's triangle tenderness -PR: tenderness on right side of rectum |
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alvarado scoring
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MANTRELS
migrating pain - 1 anorexia - 1 Nausea and vomiting- 1 Tendernss in RIF - 2 Rebound tenderness- 1 Elevated temperature- 1 Leucocytes more then 10000- 2 Shift to left with neutrophilia in PBS - 1 total score- 10 >5: not sure 5-6: compatible 6-9:probable >9-confirmed |
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sonographic findings
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TARGET sign-
noncompressible appendix >6mm AP diameter hyperechoic thickened appendix wall >2mm appendicolith periappendicular fluid |
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CT contrast findings
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- dilated appendix
- thickened wall - nonfilling of appendix by contrast or air - periappendicular fluid collection -appendicular faecolith ARROWHEAD SIGN-thivkened caecum funneling contrast into orifice of appendix |
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incisions
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-gridiron or mc.burney's or mc.arthur
- lanz's crease incision - ruherford morison muscle cutting incision - right paramedian incision - laparoscopy |
