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GI, liver, kidney > Appendicitis > Flashcards

Appendicitis Flashcards

1
Q

Pathophysiology of appendicitis?

A

INflammation of mucose -> submucosa -> mucualr and serosal - peritoneal - layers, Accumulation mucus -> ischaemia, allows bacterial advancement until perforation,
Localised peritonitis
Appendix becomes distended with pus, blockage of end arteries
Necrotic appendix if untreated will perforate, contents -> peritoneal cavity -> abscess or generalised peritonitis

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2
Q

What causes appendicitis?

A

50% unknown, 50% luminal obstruction

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3
Q

Causes of luminal obstruction

A

Faecolith
Lymphoid hyperplasia
IMpaceted stool
Foreign body
Congenital bands
Adhesions
prev infection

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4
Q

How does luminal obstruction lead to distension of appendix?

A

Increased mucus production -> bacterial overgrowth -> suppurative inflammtion -> impaired lympahtic andvenous drainage from appendix -> ischaemia and necrosis + possible perforation

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5
Q

Complications from appendicitis?

A

Delay or misdiagnosis ->
Perforation
Abscess formation
Peritonitis
Sepsus
Intra-abdominal adhesions
Bowel obstruction

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6
Q

Symptoms of appendicitis?

A

Periumbilical or epigastric worsening pain migrating to RUQ over 24-48 hours. Aggravated by movement
Low grade fever, general malaise, anorexia
N+V, sometimes diarrhoea and constipation

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7
Q

Signs of appendicits

A

Abdominal distension
Guarding
Rebound tenderness or percussion tenderness
Absent bowel sounds
Palpable abdominal mass or abscess
May present atypically esp in young, old, pregnenat

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8
Q

What to do to test pain inc hildren on exam?

A

Get to jump ir cough - worsens significatnly

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9
Q

Management of appendicitis

A

Emergency admission
Non-operative - antibiotics
Operative - appenectomy or percutaneous drainage of appendix abscess eg

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10
Q

What is the appendix?

A

6-10cm tube connected to caecam just before the colon
High concentration of GALT

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11
Q

What may be underlying cause of appendicitis?

A

Genetic factors - positive family history = 2 x risk
Environmental factors
INfection - E.coli, Bacteroides spp
Malignancy (1%) - neuroedicrine tumour of appendix, adenocarcinoma, mucinous cystadenoma

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12
Q

Which groups does perforation in appendicitis often occur?

A

Younger eg children
Over 50
Co-morbidities
Male
Time taken symptom onset to diagnsosis
5% mortality

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13
Q

Which group are more at risk of vascular sclerosis of the appendix and narrowing of the lumen by fibrosis?

A

Elderly

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14
Q

Type of pain with appendicitis?

A

Periumbilical or epigastric that worsens + migrates to RLQ over 24-48 hours
Often worsened by movement eg coughing
(Sudden relief may indicate perforation)

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15
Q

Positive findings on exam appendicitis?

A

Facial flushing, dry tongue, halitosis, low grade fever, tachy
RLQ pain/tender
Abdominal distension
Guarding (muscular rigidity)
Rebound tenderness
Absent bowel sounds = perforation or ileus
Palpable abdominal mass - appendix mass or abscess
Rosvings sign, Psoas sign, Obturator sign

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16
Q

Where is the site of maximum pain in appendicitis?

A

McBurneys point
2/3 eay along a line drawn from the umbilicus to anterior superior iliac spine

17
Q

What is Rosvings sign?

A

Palpation in LLQ increaes pain felt in RLQ

18
Q

What is psoas sign?

A

passive extension of R thigh while in L lateral pisition -> pain in RLQ

19
Q

What is obturator sign?

A

Passive internal rotation of the flexed R thigh -? pain in RLQ

20
Q

Why consider groin and scrotal examination/ pelvic examintation in GI pain?

A

Exclude alternative cause eg incarcerated hernia or testciular torsion

21
Q

Children appendicitis how present atypically?Older age?

A

Non specific abdominal pain and anorexia, withdrawn
Older - minimal pain or fever - acute confusion and shock

22
Q

How does appendicitis present in pregnancy?

A

Appendix may be displaced by gravid uterus
Later stages of pregnancy, may present with RUQ or R flank pain
N+V mistaken

23
Q

How can the anatomical position of the appendix vary

A

A retrocaecal/retrocolic appendix may present with right loin pain and tenderness, and a positive psoas test. Muscular rigidity and tenderness to deep palpation are often absent because of protection from the overlying caecum.
A pre-ileal and post-ileal appendix may present with vomiting and diarrhoea (due to irritation of the distal ileum).
A subcaecal and pelvic appendix may present with suprapubic pain and urinary frequency; diarrhoea and tenesmus may be present owing to rectal irritation; abdominal tenderness may be lacking, but rectal or vaginal tenderness may be present on the right side; microscopic haematuria and leucocytes may be present on urine dipstick testing.
A long appendix with tip inflammation in the left lower quadrant may cause pain in that region.

24
Q

Investigations to rule out alternative cause?

A

FBC
CRP
Urine dipstick test

25
Q

What is present in 80-90% of people with appendicitis on FBC?

A

Neutrophil-predominant leucocytosis

26
Q

Differential diagnosis groups

A

GI
Urological
Gynaecological
Other

27
Q

GI differential diagnosis

A

Gastroenteritis
Intestinal obstruction
Incarcerated inguinal hernia
Malrotation of midgut
Meckel diverticulum
Biliary colic and acute cholecystits
Perforated peptic ulcer
Diverticulitis
Pancreatitis
IBD
Constipation

28
Q

Urological differentials for appendicitis

A

Renal or ureteric colic
Pyelonephritis
UTI
Urinary retention
Testicular torsion

29
Q

What people do you have a low threshold for admitting in appendicitis?

A

Sus complications
Pregnant
Elderly and children

30
Q

When is imaging used in appendicitis?

A

When clinical suspicion of acute appendicitis but need to confirm for surgery, diagnosis uncertain given risks, benefits, costs and time delay

31
Q

Imaging used for appendiciits

A

US
Abdo CT
MRI
Explorative laproscopy - establish or exclude

32
Q

Non operative managmenet appendicitis when offered and what

A

Uncomplicated acute appendiciits
IV fluids
Antibiotics
Percutaneous drainage

33
Q

Gold standard treatment appendicitis

A

Appendectomy - laprascopic

34
Q

Post op complications appendectomy

A

Small bowel obstruction
Wound infection
Abscess
Stump leakage, appendiciits

GI, liver, kidney (50 decks)

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