Dse of the Anus Flashcards
(51 cards)
Appendicitis etiology or incidence? it occurs more on?
- Most commonly occurs in 10- to 19 years old
- Male > female
- 70% occurs at age < 30 years old
20% of all patient with appendicitis present with perforation, at what percentage risk is much higher?
- patients <5 or >65 years of age
what are the risk factor that causes appendicitis?
- Fecalith
- Incompletely digested food residues
- Lymphoid hyperplasia
- Intraluminal scarring
- tumor
- Bacteria
- Viruses
- IBD
what are the two categories of patient with appendicitis?
- with complicated disease like gangrene or perforation (poor prognosis)
- without complication
what are the common presenting symptoms of appendicitis?
- Abdominal pain (>95%)
- Anorexia (70%)
- Vomiting (50 -75%)
- Nausea (>65%)
- Migrating pain (50-60%)
most common appendix position and what is the maneuver utilized to diagnose this?
- Retrocecal (11 oclock)
- Iliopsoas sign
2nd most common position of appendix and what are the common presentation
- Pelvic appendix (32%)
- SSx: Dysuria, urinary frequency, diarrhea, or tenesmus
- Obturator sign
what are conditions in female that could mimic appendicitis?
- Pelvic inflammatory disease\
- ectopic pregnancy
- Ovarian torsion
where does the pain of appendicitis begins and when will it starts to migrate?
- Pain is characterized as intermittent crampy abdominal pain in the epigastric or periumbilical region
- this migrates to the RLQ over 12 -24 H
what causes the tenderness in appendicitis?
- Parietal peritoneal irritation which is associated with local muscle rigidity and stiffness
when is the expected time that predispose to perforation or development of other complication in appendicitis
- Over 48 hrs
What are the symptoms of appendicitis in elderly
- minimal pain
- nausea
- anorexia
- emesis
what is most specific imaging use to detect appendicitis?
- CT scan
Presence of:
1. dilation >6mm with wall thickening
2. lumen that does not fill with enteric contrast
3. fatty tissue stranding or air surrounding the appendix
What are seen in ultrasound in appendicitis?
- wall thickening
- Increased appendiceal diameter
- presence of free fluid
treatment for acute appendicitis?
- Appendectomy
treatment for appendicitis with the presence of Phlegmon or abscess?
- broadspectrum antibiotics
- drainage of there is an abscess >3 cm in diameter
- Parenteral fluids and bowel rest
appendix should be safely removed after 6 - 12 weeks
is a circumferential, full-thickness protrusion of the rectal wall through the anal orificie
- Rectal prolapse (procidentia)
- most common in woman > 60 years old
what are the associated developing pelvic disorder of patient with rectal prolapse?
- Urinary incontinence
- rectocele
- cystocele
- enterocele
rectal prolapse is often associated with?
- redundant sigmoid colon
- pelvic laxity
3, deep rectovaginal septum (pouch of douglas)
what is hte pathphysio of rectal prolapse
- is the result of damage to the nerve supply to hte pelvic floor muscles or pudendal nerves from repeated stretching with straining to defecate
- Thus, weaken the external anal sphincter muscles
what are common complaints of patient with rectal prolapse
- anal mass
- bleeding per rectum
- poor perianal hygiene
- Constipation occurs in 30 - 67%
what are the presenting Ssx of internal rectal prolapse?
- both constipation and incontinence
what are other associated findings in rectal prolapse?
- outlet obstruction (anismus) 30%
- Solitary rectal ulcer syndrome
- colonic inertia
what are used for evaluation of prolpse?
- cystoproctography
- colonoscopy
these evaluate for associated pelvic floor disordes and rule out a malignancy or a polyp
