GI Disorders - Appendicitis Flashcards
What is appendicitis?
inflammation of the appendix wall
Location and function of the appendix:
Location: RLQ attach to the cecum of the large intestine
Function: stores good bacteria to regenerate normal flora and remnant of evolutionary past
Acute or chronic? prevalence?
- acute onset
- usually age 5-30 y/o (peak at 20-30 y/o)
- common in younger individuals
Etiology of Appendicitis
- largely idiopathic
- twisting of the bowel or appendix: associated area become knotted and obstructed resulting in inflm
- intraluminal obstruction: fecalith may be responsible
What is a fecalith?
a small hard fecal particle
Etiology: intraluminal obstruction
When there’s a change in dig tract, there is an increase in mucous secretion which increase luminal pressure. This pressure constricts outflow of vein and blood vessels causing venous stasis.
Patho of Appendicitis
obstructed lumen –> drainage blocked (in cecum) –> increase luminal pressure (d/t increase mucous secretion)–>
exceeds venous pressure –> venous stasis–> ischemia –> infarction –> bacteria invades wall of appendix (bacteria moves to necrotic tissue in wall of appendix)
Complications of appendicitis
- perforation
- rupture of appendix
- peritonitis
manifestations
- acute pain onset in epigastric and periumbilical
- N/V
- pain increased and colicky (~12 hours)
- localized in RLQ (rebound)
- increase temp w/ leukocytes
What is colicky?
- pain arises abruptly
- sharp pain
- starts and stops continuously
- persistant pain
What type of pain is felt in appendicitis? How long does the pain localize to the appendix?
Migratory pain = pain felt somewhere disappears and felt elsewhere
It is associated with referred pain in which it is felt somewhere else than the site of injury.
In the next 12 hours.
How is nausea and vomit rely to the brain? Which pathway?
- severe pain triggers the nausea and vomit reflex center,
- the appendix is a visceral organ and when it become inflamed and painful, messages from the appendix are sent to the CNS via visceral afferent pathways
- pain sensation is carried by the afferent nerves to the pain center which is in close proximity to the N/V reflex center
Diagnosis
- hx and px (McBurney’s Point)
- US/CT to determine size
What is McBurney’s Point? Where?
o When palpate at that site there is pain and rebounding pain (tenderness)
o Anatomic location: right side of the abdomen that is 1/3 of the distance from the ant. Sup. Iliac spine to the umbilicus
Treatment (3) What sx?
- antibiotics
- IV fluids
- Appendectomy: performed in 24-48 hrs when there’s potential for rupture or perforation
