GI -appendix Flashcards
what kind of inflammation is involved in appendicitis
acute neutrophilic inflammation involving the muscle coat
what 3 features are seen in histology of appendicitis in addition to neutrophilic inflammation involving muscle coat
thickened wall
mucosal ulceration
pus in lumen
Appendicitis is caused by gut organisms invading through appendix wall after lumen obstruction by what
lymphoid hyperplasia
faecolith - perforation cause
filarial worms (nematodes residing in lymphatic tissue)
tumour (rare)
s/s appendicitis
periumbilical pain that moves to RIF nausea/vomiting tachycardia fever coughing hurts constipation/maybe diarrhoea increased WCC anorexia
what is the point at which appendicitis pain is felt in the RIF and where is this
McBurney’s point
1/3 between ASIS and umbilicus
why does the pain move from umbilicus to RIF
irritates parietal peritoneum - visceral –> parietal
what nerves are involved in peritonitis
somatic afferents
what is the first line investigation for appendicitis
what is the best investigation is unclear
U/S
CT
what are some other tests for appendicitis
PR exam Special tests - iliopsoas test - Rovings sign -Bloods
what is the iliopsoas test (posts/cope sign)
lying on side facing left with legs bent up
examiner extends the patients right leg at hip
what is Rosvings sign
pressing LIF - pain in RIF
what would bloods of appendicitis show
neutrophil leukocytosis
CRP elevation
what is the treatment of appendicitis
Laprascopic appendicectomy
metronidazole + cefuroxime
what MANTREL score indicates appendicitis is likely
7-10
what are some complications of appendicitis
mortality (pregnancy) rupture/perforation --> guarding and rebound tenderness Abscess Fistula Sepsis Liver Abscess
