Acute Appendicitis Flashcards
1
Q
Mcburneys pt
A
1/3 btw ASIS and umbillicus
2
Q
Causes
A
Obstruc- Faecolith FB Tumour Worms Trauma Lymphadenitis Decr venous drainage Thrombosis Infection. These lead to abcess, then gangrene, then perforation, then peritonitis.
3
Q
Early symps
A
Periumb pain Dull pain Colicky Anorexia Vomiting Diarrhoea
4
Q
Later symps
A
RIF pain, constant
Worse with movem
Fever
5
Q
Late symps
A
Lower abdo pain
Generalised severe pain
6
Q
Diffs
A
Cholecystitis Ulcer Obstruc Pancreatitis Diverticulitis Perforation IBD Infec Meckels Mesenteric adenitis-yng, assoc URTI Hernia AAA Gynae eg ectopic preg, PID, ovarian cyst and torsion, CL cyst, uterine fibroid. Urology eg pyelonephritis, stones, testic torsion, MSK, shingles.
7
Q
Signs
A
RIF tenderness
Rebound
Guarding
Rovsings sign press left IF causes pain on R
Psoas sign pain on hip flex against resis
Obturator sign pain when flex hip and int rot
Tachy
Temp
Flushing
Fetor
PR
8
Q
Ix
A
FBC, UE, amylase, LFT, CRP Urine, preg Sepsis screen US non compressible tube, excludes gynae CT Alvarado score
9
Q
Mx
A
ABC and monit Analgesia NBM/IVI DVT prophylaxis ?AB Senior review Obs and re assess Further ix Surgery AB only- uncomplicated, but little ev
10
Q
Laparoscopy risks
A
Infec- wound or pelvic abcess Bleed BV or bowel damage Fistulation Conversion to open DVT, PE Hernia Resection, stoma
11
Q
Pregnancy
A
Caecum pushed to RUQ
US
MRI
12
Q
Appendix mass
A
Inflammatory phlegmon Small bowel and omentum adherent Tx with AB if sys well Drain abcess percut Deter us reqs laparotomy and risk hemicolectomy
