appendicitis

Question 1

cause

Answer 1

obstruction dt: fecalith, intestinal parasite, inflammation, neoplasm

Question 2

S&S early stage

Answer 2

vague, colicky,
periumbilical abd pain
n/v
12-24 hrs pain migrates rlq, fever

Question 3

atypical symptoms

Answer 3

indigestion
flatulence
diarrhea
malaise
12-24 hrs pain migrates rlq, fever

Question 4

classic signs

Answer 4

McBurney sign: deep tenderness located 2/3 of distance from umbilicus to r anterior superior iliac spine

Rovising sign; llq ilicits rlq pain

iliopsoas test: straight leg lift

obturator test: lift bended leg and rotate knee outward

Question 5

rupture

Answer 5

obstruction persist presure builds and wall of lumen becomes weak until it ruptures
spills bacteria into peritoneum causing peritonitis

Question 6

S&S

Answer 6

abd guarding: early sign of peritoneal irritation

rebound tenderness: palpation and quick release, pain felt on release

Question 7

labs

Answer 7

bld
wbc
increased crp
dehydration or fluid/electrolyte imbalance
UA: r/o genitourinary cond
preg test: urine/serum

Question 8

radiological test

Answer 8

plain abd film: not useful
US: enlarged append diameter >6 cm= abscess: increased echogenicity of periappendiceal fat and appendicolith
CT: done as fu if US inconclusive= enlarged appendix, appendiceal wall thickens >2mm

Question 9

what is appendicitis commonly confused as

Answer 9

gastroenteritis and GYN disorders

Question 10

tx of classic findings

Answer 10

classic findings: immediate sx without imaging

Question 11

tx of atypical presentations

Answer 11

further test to r/o bowel obstruction, ovarian/testicular torsion, kidney stone

Question 12

appendectomy acute nonperforated tx

Answer 12

acute nonperforated should be done w/in 12 hrs of dx

Question 13

preop management

Answer 13

iv rehydration

rebalance electrolytes

Question 14

prophylactic abx tx

Answer 14

as soon as dx made and <30 min before surgical incision
iv 2 gm cefoxitin or cefotetan
or
2 gm cefazolin + flagyl
if allergic: clindamycin +
cipro or levo or gentamycin

Question 15

S&S and tx of perforation or gangrene

Answer 15

gen peritonitis,, hemodynamic instability=

emergency appy with I&D

Question 16

post op care

Answer 16

clear liq AAT
dc when afebrile and tolerates diet
abd not needed post sx

Question 17

non op tx for local symptoms w/ no gen peritonitis

Answer 17

tx nonoperative
phlegmon
tx IVF, ABX
repeat imaging to fu progression
ct guided percutaneous drainage
may need apply eventually