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98 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Most common age group for appendicitis
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10-40 y/o, but can occur at any age
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Cause of appendicitis
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obstruction in lumen of appendix that causes swelling and eventually decreases blood supply to the wall of the appendix
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What causes distention of the appendix in appendicitis?
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due to trapped secretions
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What type of pain is caused by distention of the appendix?
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periumbilical pain
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What causes inflammation and then suppuration in appendicitis?
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due to invasion of bacteria into wall
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Type of pain causes by inflammation in appendicitis.
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RLQ pain
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What is the cause of rupture in appendicitis?
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increasing distention and decreased blood supply to the wall of the appendix
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Why is there not a sudden onset of symptoms in appendicitis?
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because the swelling and injection take hours to develop
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What symptom will develop as the appendix distends?
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nausea, and later vomiting; abdomen not tender yet
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What symptoms occur when the appendix wall looses blood supply and bacteria invade the wall?
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pain and tenderness RLQ, low grade fever, and mildly increased WBC
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What signs and symptoms occur when the appendix wall perforates and feces and bacteria spill out?
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more pain and tenderness, more fever, and higher WBC
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If the appendix is in the iliac fossa, where does tenderness develop?
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McBurney’s point
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If the appendix is in the pelvis, where does tenderness develop?
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rectal pain
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If the appendix is retrocecal, where does tenderness develop?
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flank
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What is a fecolith or appendicolith?
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piece of stool in appendix (may become calcified)
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What does the pneumonic MANTRELS stand for?
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appendicitis symptoms- migration to R Iliac Fossa, anorexia, nausea/vomiting, tenderness in R iliac fossa, Rebound pain, Elevated temp, Leukocytosis, Shift of Leukocytes to left
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What is Alvarado’s score?
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point system based on history, PE, and lab tests that is used as a scale for diagnosing acute appendicitis
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Management of appendicitis patient pending surgery.
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NPO, IV fluids at greater than maintenance rate, Antibiotics, NG suction if still vomiting after NPO, and pain medication (controversial)
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Why is the use of pain medication in the management of appendicitis controversial?
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might obscure signs and symptoms; might delay needed surgery
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Classical antibiotics used to treat appendicitis
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Ampicillin, Clindamycin, Gentamicin, and Erythromycin
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Examples of more modern monotherapy used to treat appendicitis
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Cefoxitin, Cefotetan, and Ceftizoxime
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What is the goal in treatment once appendicitis is diagnosed?
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to operate prior to perforation or rupture
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Why is there no need to crossmatch and type prior to surgery for appendicitis?
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rupture or perforation does not involve bleeding
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Type of incision used in an “open” appendectomy.
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McBurney or Rocky-Davis incision
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Which type of appendectomy gives better visualization of he abdomen and pelvis?
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laparoscopic appendectomy
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Most common age group for appendicitis
|
10-40 y/o, but can occur at any age
|
|
|
|
Cause of appendicitis
|
obstruction in lumen of appendix that causes swelling and eventually decreases blood supply to the wall of the appendix
|
|
|
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What is phelgmon?
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inflammation without gross pus----appendectomy may be delayed in these selected cases with initial tx being NPO, IV fluids, and antibiotics
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What causes distention of the appendix in appendicitis?
|
due to trapped secretions
|
|
|
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What is suppurative appendicitis?
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early appendicitis- diagnosis at this degree of infection is desirable
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|
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What type of pain is caused by distention of the appendix?
|
periumbilical pain
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|
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What is gangrenous appendicitis?
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part of the wall is necrotic; almost perforated
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What is perforated appendicitis?
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appendicitis that presents in one of 2 ways--generalized peritonitis or localized abscess
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What causes inflammation and then suppuration in appendicitis?
|
due to invasion of bacteria into wall
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Treatment for localized abscess.
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antibiotics and US or CT guided percutaneous drainage, then an appendectomy 6 weeks later
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Type of pain causes by inflammation in appendicitis.
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RLQ pain
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Post op diagnosis and naming of appendicitis involves what two parts.
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based on degree of infection and location
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What is the cause of rupture in appendicitis?
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increasing distention and decreased blood supply to the wall of the appendix
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What form number is the consent form for anesthesia and performance of operations?
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SF 522
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Why is there not a sudden onset of symptoms in appendicitis?
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because the swelling and injection take hours to develop
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|
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What symptom will develop as the appendix distends?
|
nausea, and later vomiting; abdomen not tender yet
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What does the abbreviation “S/P” mean?
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status post = has had a surgery (include when)
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MC complication of appendicitis.
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wound infection
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What symptoms occur when the appendix wall looses blood supply and bacteria invade the wall?
|
pain and tenderness RLQ, low grade fever, and mildly increased WBC
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Treatment of superficial infection after appendectomy.
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treat as outpatient-- wound care, oral antibiotics, and frequent follow up
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What signs and symptoms occur when the appendix wall perforates and feces and bacteria spill out?
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more pain and tenderness, more fever, and higher WBC
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Treatment of pelvic abscesses after appendectomy.
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inpatient care with IV antibiotics
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If the appendix is in the iliac fossa, where does tenderness develop?
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McBurney’s point
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S/S of viral gastroenteritis
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CC usually diarrhea, hyperactive bowel sounds, and probably no signs of peritonitis
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If the appendix is in the pelvis, where does tenderness develop?
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rectal pain
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S/S of gastroenteritis causes by Salmonella, Campylobacteria, etc.
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CC usually diarrhea, maybe fever and chills, not necessarily signs of peritonitis
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If the appendix is retrocecal, where does tenderness develop?
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flank
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How can UTI usually be differentiated from appendicitis?
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usually just from symptoms, but also from WBC in urine---there will be many with a UTI and only some with appendicitis
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What is a fecolith or appendicolith?
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piece of stool in appendix (may become calcified)
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S/S of ureteral stone
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SUDDEN onset of severe pain with no peritonitis
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What does the pneumonic MANTRELS stand for?
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appendicitis symptoms- migration to R Iliac Fossa, anorexia, nausea/vomiting, tenderness in R iliac fossa, Rebound pain, Elevated temp, Leukocytosis, Shift of Leukocytes to left
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What is Mittelschmerz?
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midcycle ovulation pain---not an infection; patient will have had LMP about 2 weeks ago and there will be no vomiting, fever, or peritonitis
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What is Alvarado’s score?
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point system based on history, PE, and lab tests that is used as a scale for diagnosing acute appendicitis
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|
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4 GYN conditions often mistaken for appendicitis
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ectopic pregnancy, PID, ovarian cyst, and Mittelschmerz
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Management of appendicitis patient pending surgery.
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NPO, IV fluids at greater than maintenance rate, Antibiotics, NG suction if still vomiting after NPO, and pain medication (controversial)
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|
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What type of pain and symptoms are present with PID?
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bilateral adnexal tenderness rather than just RLQ like in appendicitis, cervical motion tenderness, and discharge from cervical os
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If surgeon finds Meckels’ diverticulum, what is removed during surgery?
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Meckel’s and appendix
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Why is the use of pain medication in the management of appendicitis controversial?
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might obscure signs and symptoms; might delay needed surgery
|
|
|
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If appendix is found to be normal during surgery, but Crohn’s is found, what is the treatment?
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appendix is removed and Crohn’s treated medically
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Classical antibiotics used to treat appendicitis
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Ampicillin, Clindamycin, Gentamicin, and Erythromycin
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|
|
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2 types of mucosa in Meckel’s diverticulum
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pancreatic and gastric
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Examples of more modern monotherapy used to treat appendicitis
|
Cefoxitin, Cefotetan, and Ceftizoxime
|
|
|
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S/S of Crohn’s disease
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diarrhea, past history of similar attacks, positive guaiac
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What is the goal in treatment once appendicitis is diagnosed?
|
to operate prior to perforation or rupture
|
|
|
|
Patients with diverticulosis- usually older or young?
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older
|
|
|
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Why is there no need to crossmatch and type prior to surgery for appendicitis?
|
rupture or perforation does not involve bleeding
|
|
|
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What side is diverticulosis usually found on in Western countries?
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left sided
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courtyard / внутренний двор/ にわ/テイ
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庭
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cave court...courtyard
Chief's court took place in a courtyard of a cave. |
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|
Which type of appendectomy gives better visualization of he abdomen and pelvis?
|
laparoscopic appendectomy
|
|
|
|
What is phelgmon?
|
inflammation without gross pus----appendectomy may be delayed in these selected cases with initial tx being NPO, IV fluids, and antibiotics
|
|
|
|
What is suppurative appendicitis?
|
early appendicitis- diagnosis at this degree of infection is desirable
|
|
|
|
What is gangrenous appendicitis?
|
part of the wall is necrotic; almost perforated
|
|
|
|
What is perforated appendicitis?
|
appendicitis that presents in one of 2 ways--generalized peritonitis or localized abscess
|
|
|
|
Treatment for localized abscess.
|
antibiotics and US or CT guided percutaneous drainage, then an appendectomy 6 weeks later
|
|
|
|
Post op diagnosis and naming of appendicitis involves what two parts.
|
based on degree of infection and location
|
|
|
|
What form number is the consent form for anesthesia and performance of operations?
|
SF 522
|
|
|
|
What does the abbreviation “S/P” mean?
|
status post = has had a surgery (include when)
|
|
|
|
MC complication of appendicitis.
|
wound infection
|
|
|
|
Treatment of superficial infection after appendectomy.
|
treat as outpatient-- wound care, oral antibiotics, and frequent follow up
|
|
|
|
Treatment of pelvic abscesses after appendectomy.
|
inpatient care with IV antibiotics
|
|
|
|
S/S of viral gastroenteritis
|
CC usually diarrhea, hyperactive bowel sounds, and probably no signs of peritonitis
|
|
|
|
S/S of gastroenteritis causes by Salmonella, Campylobacteria, etc.
|
CC usually diarrhea, maybe fever and chills, not necessarily signs of peritonitis
|
|
|
|
How can UTI usually be differentiated from appendicitis?
|
usually just from symptoms, but also from WBC in urine---there will be many with a UTI and only some with appendicitis
|
|
|
|
S/S of ureteral stone
|
SUDDEN onset of severe pain with no peritonitis
|
|
|
|
What is Mittelschmerz?
|
midcycle ovulation pain---not an infection; patient will have had LMP about 2 weeks ago and there will be no vomiting, fever, or peritonitis
|
|
|
|
4 GYN conditions often mistaken for appendicitis
|
ectopic pregnancy, PID, ovarian cyst, and Mittelschmerz
|
|
|
|
What type of pain and symptoms are present with PID?
|
bilateral adnexal tenderness rather than just RLQ like in appendicitis, cervical motion tenderness, and discharge from cervical os
|
|
|
|
If surgeon finds Meckels’ diverticulum, what is removed during surgery?
|
Meckel’s and appendix
|
|
|
|
If appendix is found to be normal during surgery, but Crohn’s is found, what is the treatment?
|
appendix is removed and Crohn’s treated medically
|
|
|
|
2 types of mucosa in Meckel’s diverticulum
|
pancreatic and gastric
|
|
|
|
S/S of Crohn’s disease
|
diarrhea, past history of similar attacks, positive guaiac
|
|
|
|
Patients with diverticulosis- usually older or young?
|
older
|
|
|
|
What side is diverticulosis usually found on in Western countries?
|
left sided
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