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Surgical Recall > Chapter 44: Appendix- Appendicits > Flashcards

Chapter 44: Appendix- Appendicits Flashcards

1
Q

What is it?

A

Inflammation of the appendix caused by obstruction of the appendiceal lumen,producing a closed loop with resultant inflammation that can lead to necrosis andperforation

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2
Q

What are the causes?

A

Lymphoid hyperplasia, fecalith (a.k.a. “appendicolith”)

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3
Q

What is the lifetime incidence of acute appendicitis in the UnitedStates?

A

≈7%!

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4
Q

What is the most common cause of emergent abdominal surgery inthe United States?

A

Acute appendicitis

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5
Q

How does appendicitis classically present?

A
  1. Periumbilical pain (intermittent and crampy)
  2. Nausea/vomiting
  3. Anorexia
  4. Pain migrates to RLQ
    • (constant and intense pain)
    • usually in <24 hours
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6
Q

Why does periumbilical pain occur?

A

Referred pain

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7
Q

Why does RLQ pain occur?

A

Peritoneal irritation

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8
Q

What are the signs/symptoms?

A

Signs of peritoneal irritation may be present:

  • guarding
  • muscle spasm
  • rebound tenderness
  • obturator and psoas signs
  • low-grade fever (high grade if perforation occurs)
  • RLQ hyperesthesia
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9
Q

Obturator sign

A
  • Pain upon internal rotation of the leg with the hip and knee flexed
  • seen inpatients with pelvic appendicitis
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10
Q

Psoas sign

A
  • Pain elicited by extending the hip with the knee in full extension or by flexing the hip against resistance
  • seen classically in retrocecal appendicitis
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11
Q

Rovsing’s sign

A
  • Palpation or rebound pressure of the LLQ results in pain in the RLQ
  • seen in appendicitis
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12
Q

McBurney’s point

A

Point one third from the anterior superior iliac spine to the umbilicus (often the point of maximal tenderness)

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13
Q

What is the differential diagnosis for everyone

A
  • Meckel’s diverticulum
  • Crohn’s disease
  • perforated ulcer
  • pancreatitis
  • mesenteric lymphadenitis
  • constipation
  • gastroenteritis
  • intussusception
  • volvulus
  • tumors
  • UTI (e.g., cystitis)
  • pyelonephritis
  • torsed epiploicae
  • cholecystitis
  • cecal tumor
  • diverticulitis (floppy sigmoid)
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14
Q

What is the differential diagnosis for females

A
  • Ovarian cyst
  • ovarian torsion
  • tuboovarian abscess
  • mittelschmerz
  • pelvicinflammatory disease (PID)
  • ectopic pregnancy
  • ruptured pregnancy
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15
Q

What lab tests should be performed?

A
  1. CBC: increased WBC (>10,000 per mm3 in >90% of cases)
    • most often with a“left shift”
  2. Urinalysis: to evaluate for pyelonephritis or renal calculus
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16
Q

Can you have an abnormal urinalysis with appendicitis?

A

Yes; mild hematuria and pyuria are common in appendicitis with pelvicinflammation, resulting in inflammation of the ureter

17
Q

What additional tests can be performed if the diagnosis is not clear?

A

Spiral CT scan

U/S (may see a large, noncompressible appendix or fecalith)

18
Q

In acute appendicitis, what classically precedes vomiting?

A

Pain

(in gastroenteritis, the pain classically follows vomiting)

19
Q

What radiographic studies are often performed?

A
  1. CXR: to rule out RML or RLL pneumonia, free air
  2. AXR: abdominal films are usually nonspecific, but calcified fecalith present in≈5% of cases
20
Q

What are the CT scan findings with acute appendicitis?

A
  • Periappendiceal fat stranding
  • appendiceal diameter >6 mm
  • periappendiceal fluid
  • fecalith
21
Q

What are the preoperative medications/preparation?

A
  1. Rehydration with IV fluids (LR)
  2. Preoperative antibiotics with anaerobic coverage (appendix is considered partof the colon)
22
Q

What is a lap appy?

A

Laparoscopic appendectomy;

  • used in most cases in women (can see adnexa)
  • if patient has a need to quickly return to physical activity
  • obese
23
Q

What is the treatment for nonperforated acute appendicitis?

A

Nonperforated—

  • prompt appendectomy (prevents perforation)
  • 24 hours of antibiotics
  • discharge home usually on POD #1
24
Q

What is the treatment for perforated acute appendicitis?

A

Perforated—

  • IV fluid resuscitation and prompt appendectomy
  • all pus is drained with postoperative antibiotics continued for 3 to 7 days
  • wound is left open in most cases of perforation after closing the fascia
    • (heals by secondary intention or delayed primary closure)

NOTE: Check first aid

25
Q

How is an appendiceal abscess that is diagnosed preoperatively treated?

A
  • Percutaneous drainage of the abscess
  • antibiotic administration
  • elective appendectomy ≈6 weeks later (a.k.a. “interval appendectomy”)
26
Q

If a normal appendix is found upon exploration, should you take out the normal appendix?

A

Yes

27
Q

How long after removal of a NONRUPTURED appendix should antibiotics continue postoperatively?

A

For 24 hours

28
Q

Which antibiotic is used for NONPERFORATED appendicitis?

A

Anaerobic coverage:

  • Cefoxitin®
  • Cefotetan®
  • Unasyn®
  • Cipro®
  • Flagyl
29
Q

What antibiotic is used for a PERFORATED appendix?

A

Broad-spectrum antibiotics:

  • amp/Cipro®/clinda

or

  • a penicillin such as Zosyn®
30
Q

How long do you give antibiotics for perforated appendicitis?

A

Until the patient has a :

  1. normal WBC count
  2. afebrile
  3. ambulating
  4. eating a regular diet

(usually 3 to 7 days)

31
Q

What is the risk of perforation?

A

≈25% by 24 hours from onset of symptoms

≈50% by 36 hours

≈75% by 48hours

32
Q

What is the most common general surgical abdominal emergency in pregnancy?

A

Appendicitis (about 1/1750)

appendix may be in the RUQ because of theenlarged uterus)

33
Q

What are the possible complications of appendicitis?

A
  • Pelvic abscess
  • liver abscess
  • free perforation
  • portal pylethrombophlebitis (very rare)
34
Q

What percentage of negative appendectomies is acceptable?

A

Up to 20%; taking out some normal appendixes is better than missing a case ofacute appendicitis that eventually ruptures

35
Q

Who is at risk of dying from acute appendicitis?

A

Very old and very young patients

36
Q

What bacteria are associated with “mesenteric adenitis” that canclosely mimic acute appendicitis?

A

Yersinia enterocolitica

Surgical Recall (168 decks)

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