FN: Acute appendicitis Flashcards Preview

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Flashcards in FN: Acute appendicitis Deck (22):
1

Definition

Inflammation of the vermiform apendix ranging from oedema to ischaemia necrosis and perforation

2

Epi

Incidence: 6% lifetime incidence, commonest surgical emergency
Age: rare

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Pathogeneis:

1. Obstruction of the appendic
2. Gut organisms

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Obstruction

1. feacolith most commonly
2. Lymphoid hyperplasia post-infection
3. Tumour (e.g. caecal Ca, carcinoid)
4. Worms (e.g. ascaris lumbicoides, schisto)

5

Gut infection and compications

Infection behind obstruction
Oedema + ischaemia + necrosis and perforation
1. Peritonitis
2. Abcess
3. Appendix mass

6

Signs

Low-grade pyrexiaL 37.5-38.5
raised HR, shallow breathing
Foetor oris
Guarding and tenderness @ Mc burneys point +cough/percussion tenderness
Apppendix mass may be palpable
Pain PR suggest pelvic appendix

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Special signs

Rovsings sign
Psoas sign
Bope sign

8

Rovsings

Pressure in LIF = more pain in RIF

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Psoas sign

Pain on extending the hip: retrocaecal appendix

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Cope sign

Flexion + internal rotation of R hip - pain: appendix lying close to obturator internus

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Differential: surgical

Cholecysitis
Diverticulitis
Meckels diverticulitis

12

Differential: gynae

Cyst accident: torsion, rupture, haemorrhage
Salpingitis/PID
Ruptured ectopic

13

Differential: Medical

Mesenteric adenitis
UTI
Crohns

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Investigations

Bloods: FBC, CRP, amylase, G+S, clotting

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Urine shows

Sterile pyuria, may indicate bladder irritation
Ketones: anorexia
Exclude UTI
Beta-HCG

16

Imaging

US: exlcude gynae pah, visulaise inflamed appendix
CT: can be used

17

Diagnostic

Lap

18

Management

Fluids
Abx: cef 1.5g + met 500g IV TDS
analgesia
Certain Dx: appendicectomy (open or lap)
Uncertain Dx: Active observation

19

complications

1. inflamed appendix with adherent covering of omentum and smll bowel
Dx: US or CT
Management
1. Initially: ABx + NBM
2. Resolution of mass - interval appendicectomy
3. Exlcude a colonic tumour: colonoscopy

20

appendix abscess

results if appendic mass doesnt resolve
Mass enlarges, pt. deteriorates

21

Appendix abscess management

Abx + NBM
Ct- guided percutaneous drainage
If no resolution, surgery may involve right hemicolectomy

22

Perforation

commoner if faecolith present and in young children (as Dx is often delayed)
Deteriorating with peritonitis

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