Appendix Flashcards
(12 cards)
The incidence of appendectomy for acute appendicitis increased exponentially mainly due to?
Increased used of diagnostic imaging and detection of appendicitis that otherwise would have resolved
Graded compression ultrasonography
- inexpensive and rapid
- The appendix is identified as non peristaltic, blind ending loop of bowel
- The compressibility and anteroposterior dimensions are measured
- Thickening of the wall as well as peri-appendiceal fluid with a non comprehensible appendix are suggestive of appendicitis.
- A fecalith in mid appendix may allow proximal filling of the appendix with barium in the presence of appendicitis
Difference comparing urgent versus appendectomy
No difference in perforation rates, surgical site infection, abscess, conversion rate or operative time
A 55 year old man has CT evidence of complicated appendicitis with a contained abscess in the RLQ. He is mildyly tachycardic, afebrile, and normotensive with a focal RLQ tenderness but no peritonitis. What is the optimal approach to this patient?
Pecutaneous drainage, IV fluids, bowel rest, and broad spectrum antibiotics
- Conservative managment of the physiologically stable patient with complicated appendicitis has been shown to be associated woth fewer overall complications, fewer bowel obstructions, fewer intra-abdominal abscessees and fewer reoperations
A 23 year old woman who is 28 weeks pregnant presents with right sided abdominal pain, leukocytosis, and an abdmonila ultrasound that does not visualize the appendiz. What inerventions would you recommend>
Abdominal MRI scan
A 34 year old man presents to your clinic asking about an elective appendectomy. he has no history of appendicitis. What are the possible indications for appendectomy?
- Planned travel to a remote place with no surgical care
- Patients with crohn diseaes where the cecum is free of gross disease
- As part of Ladd proceudre
While reviewing pathology of a recent laparoscopic appendectomy, you note that in additon to acute appendicitis, the patient had a 1.5 cm carcinoid tumor located at the base of the appendix. The patient is otherwise healthy and recovering well from the surgery. What would you recommend?
Right hemicolectomy
- Appendiceal carcinoid is one of the msot common neoplasms to identify
- <1 cm generally do not require therapy
- larger than 1 or 2 cm, involving the appendiceal base or with LN metastasis of mesenteric invasion warrant a right hemicolectomy
- Adjuvant chemo could be considered but only after definitive surgical care
An 8 year old boy presents to the emergency department complaining of generalized abdominal pain for the past 24 hours. Laboratory tests reveal leukocytosis of 13000 and he is tender in the RLQ on physical examination. He is taken to the operating room for laparoscopic appendectomy. Removal of the appendix has been associated with a protective effect of ______________
Ulcerative colitis
Physical signs of Appendicitis
- Rovsing sign: pain in the RLQ on palpation of the LLQ
- Dunphy sign: Elicits pain with coughing and is related to inflammation of the peritoneum
- Obturator sign: occures with internal roataion of the right hip
- iliopsoas sign: pain with extension of the right hip, attribute to a retrocecal appendix
A 29 year old woman presents with RLQ pain, fever, and leukocytosis. Prior to imaging studies, the Alvarado score is used to determine the patient’s likelihood of having appendicitis. What are the components of alvarado score
- Migratory pain
- Anorexia
- Nausea and vomiting
- Tenderness (2)
- Rebound tenderness
- Fever
- Leukocytosis
- Shift to the left
<3 Low likelihood
4-6 consider further imaging
>7 high likelihood of appendicits
A 34 year old man undergoes an uneventful appendectomy for acute, non perforated appendicitis, The pathology report notes reads: acute inflammation with a 1 cm adenocarcinoma of the mid appendix. This patient should have_______-
Right hemicolectomy
- Priamry adenocarcinoma of the appendix is rare
- mucinous
- colonic
- adenocarcinoid
A 45 year old woman present with RLQ pain. A CT scan is performed. What finding on the CT scan is most suggestive of appendiceal lymphoma
Appendiceal diameter >2.5cm or surrounding soft tissue thickening
