Appendicitis Flashcards
(41 cards)
What is appendicitis?
Inflammation of the appendix caused by obstruction of the appendiceal lumen, producing a closed loop with resultant inflammation that can lead to nerosis and perforation
What are the causes of appendicitis?
Lymphoid hyperplasia, fecalith (appendicolith)
Rare: parasite, foreign body, tumor (carcinoid)
Lifetime incidence of acute appendicitis in US?
~7%
What is the classic presentation if appendicitis in chronologic order?
- Periumbilical pain (intermittent and crampy)
- nausea/vomiting
- anorexia
- pain migrates to RLQ (constant/intense pain) usually in <24 hours
Why does the periumbillical pain occur?
It is referred pain
Why does the RLQ pain occur?
Peritoneal irritation
What are the signs/sx of appendicitis?
Signs of peritoneal irritation: guarding, muscle spasm, rebound tenderness, obturator and psoas signs, low-grade fever (high-grade if perforation), RLQ hyperesthesia
What is the obturator sign?
Pain upon internal rotation of the leg with the hip and knee flexed
seen in patients with pelvic appendicitis
What is the psoas sign?
Pain elicited by extending the hip with the knee in full extension or by flexing the hip against resistance
Seen classically with retrocecal appendicitis
What is Rovsing’s sign?
Palpation or rebound pressure of the LLQ results in pain in the RLQ
What is Valentino’s sign?
RLQ pain/peritonitis from succus draining down to the RLQ from a perforated gastric duodenal ulcer
What is McBurney’s point?
Point one third from the ASIS to the umbilicus (often point of maximal tenderness)
What are some DDx for everyone with possible appendicitis?
Meckel’s diverticulum
Chron’s
perforated ulcer
pancreatitis
mensenteric lymphadenitis
constipation
gastroenteritis
pyelonephritis/UTI
Diverticulitis
What are some Ddx for females with possible appendicitis?
Ovarian cyst
Ovarian torsion
Tuboovarian abscess
mittlelschmerz
PID
ectopic/ruptured PG
What labs should be performed with possible appendicitis?
CBC: increase WBC (usually >10,000 and with left shift)
UA to evaluate for Pyelo/renal calculus
Can you have an abnormal UA with appendicitis?
Yes!
Mild hematuria and pyuria are common if there is pelvic inflammation with the appendicitis leading to ureter inflammtion
What diagnostic tests can be performed if the diagnosis is not clear?
Spiral CT
U/S (may see large, noncompressible appedix or fecalith)
AXR
What classically precedes vomiting in appendicitis?
Pain
(in gastroenteritis- the pain usually FOLLOWS vomiting)
What radiographic studies are often performed with appendicitis?
CXR: to rule out RML or RLL pneumonia and free air
AXR: usually non-specific, but calcified fecalith in about 5% of cases
What are radiographic signs of appendicitis on AXR?
Fecalith
Sentinel loops
Scoliosis away from the right because of pain
Mass effect (abscess)
Loss of psoas shadow
Loss of preperitoneal fat stripe
rarely: free air if perforation
___% of cases a radiopaque fecalith will be on a ABX with appendicitis?
~5%
What are the preoperative meds/preps for appendicitis?
Rehydration with IV fluids (lactated ringers)
Preoperative antibiotics with anaerobic coverage
What is a lap appy?
Laparoscopic appendectomy: used in most cases in women (can see adnexa) or if patinet has a need to quickly return to physical activity, or is obese
Tx for non-perforated acute appendicitis?
Prompt appendectomy (to prevent perforation), 24 hours of antibiotics, discharge home usually on POD #1
