Acute Appendicitis Flashcards Preview

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Flashcards in Acute Appendicitis Deck (12)
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1

Mcburneys pt

1/3 btw ASIS and umbillicus

2

Causes

Obstruc-
Faecolith
FB
Tumour
Worms
Trauma
Lymphadenitis
Decr venous drainage
Thrombosis
Infection.
These lead to abcess, then gangrene, then perforation, then peritonitis.

3

Early symps

Periumb pain
Dull pain
Colicky
Anorexia
Vomiting
Diarrhoea

4

Later symps

RIF pain, constant
Worse with movem
Fever

5

Late symps

Lower abdo pain
Generalised severe pain

6

Diffs

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

Signs

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

Ix

FBC, UE, amylase, LFT, CRP
Urine, preg
Sepsis screen
US non compressible tube, excludes gynae
CT
Alvarado score

9

Mx

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

Laparoscopy risks

Infec- wound or pelvic abcess
Bleed
BV or bowel damage
Fistulation
Conversion to open
DVT, PE
Hernia
Resection, stoma

11

Pregnancy

Caecum pushed to RUQ
US
MRI

12

Appendix mass

Inflammatory phlegmon
Small bowel and omentum adherent
Tx with AB if sys well
Drain abcess percut
Deter us reqs laparotomy and risk hemicolectomy