GIT Flashcards

Question

Discuss causes of pancreatitis and list the three most common

Answer 1

Three most common 1) Gall stones (40-70%) - more common in females 2) ETOH 25-35% ( more common in men) 3) ERCP Toxic-metabolic - ALcohol - drugs - hyperlipidaemia - hypercalcaemia - Uremia - Scorpian venom Mechanical or obstuctive - Bilary stones - Congenital - pancreas divisum, annula pancreas - Tumors- umpullary, neuroendorcrine, pancreatic carcinoma - Post ERCP - Ampullary dysfunction or stenosis - Duodenal diverticulum - Trauma Infection - Viral (CMV, mumps, coxsackie, HIV, EBV, varicella) - Bacterial - TB, salonella, Campylobacter legionella, mycoplasma, - Parasitic - ascaris Vascular - Vasculitis - embolic - hypoperfusion - hypercoagulability Other - idiopathic - herediatry - DM-DKA - Autoimmune

Answer 2

Begins with an exciting event wether that be toxic or metabolic such as ETOH, hyperlipidaemia or obstruction from gall stones Cellular injury disrupts usual trafficking of enzymes and leads to activtion of trypsinogen and other digestive enymes This in turn leads to autodigestion of the pancreatic tissue initiating both local and systemic inflammatory cascades Locally cytockines cause increased vascular permeability which can results in complications such as oedema, haemorrhage and necrosis Systemic inflammation may lead to SIRS, shock and sepsis.

Answer 3

Cna be classifed by type (interstitial odematous or necrotic) and be local complictions Most patient will have interstial odematous disease which usually resolves within a week About 5-10% of patient will develop necrotising pancreatitis which can involve pancreatic parenchyma and surrounding tissues, Local complications as defined by the revised 2012 Atlanta Clssification are categorised based on which type of pancreatitis has occured

Answer 4

Interstitial oedematous type - Acute peripancreatic fluid collection -- within 4 weeks of infection no wall - psuedocyst formation more than 4 weeks after infection -- well formed wall Necrotic pancreatitis - Acute necrotic collection -- heterogenous collection of fluid and necrosis: intrapancreatic and/or extrapancreatic - walled off necrosis- heterogenous collection of fluid and necrosis with well defined wall: intra or extrapancreatic seen > 4 weeks from symptom onset Other local complications - bowel necrosis - splenic or portal vein thrombosis - GIT bleed - Gastric outlet obstruction

Answer 5

Related to progression of local inflammation. If persistant can lead to fluminant sepsis, shock and organ failure. Pulmonary - ARDS - due to microvascular damage and increase permeability, also can have direct surfactant degradating affect - Atelectasis - Pleural effusion in up to 50% of cases usually on the left CVS - hypovolaemic shock secondary to fluid shift Coagulopathy - DIC - Thrombocytopenia Metaboic - hyperglycaemia - hypocalcaemia from low albuin and magnesium levels

Answer 6

Rapid onset of contant epigastric or left upper quadrant pain. Usually moderate to severe in nature having nil correlation to severity of disease Vitals reflect patient discomfort and inflammation with tachycardia, tachypnoea and hihg temp Respiration can be shallow due to splinting jaundice if obstruction present Abdomen can be distended Cullens and gray turners are rare but in cases of necrotic haemorrhagic pancreatitis are signs of poor prognosis Tender epigastrium with gaurding and rebound

Answer 7

Abdominal - GUD - Bilary colic - cholecysitis - cholangitis - Gastroenteritis - ureteral stone - bowel obsturction - mesenteric ischaemia - AAA - ectopic pregnancy - perf ``` Cardiopulonmary -ACS -Pneumonia pericarditis -pleural effusion ``` Systemic disorders - DKA - SIckle cell disease

Answer 8

Lipase more specific and sensitive 96%,99% Amylase less sensitivity with 78 and 99% respectively Amylase is produced in both pancreas and salivary and is raised for a range of resions including - malignancy, - trauma, burns , salivary and liver disease, cholecystitis, renal failure, HIV and pregnancy

Answer 9

Rarlely needed as a routine investigation in pancreatitis Reasons for CT include 1) diagnostic uncertainty 2) to excude other suscpected DDX 3)to assess for complications in patient who fail to respond to treatment within 48 hours The evaluation of complications with CT is best performed 3-7 days after onset of illness. DUring the first few days it doe not accuratley identify the degree of pancreatic necrosis. Complications such as abcess or pseudocust do not occur for several weeks Ct finding include - enlargement of the gland - loss of typical texture and borders - surrounding fluid and fat straning - areas demonstrating nil enhancing with contrast are likley necrotic

Answer 10

Criteria used to classify severity of pancreatitis -- severe pancreatitis cannot be classified until 48 horus MILD - no organ failure - no local or systemic complications Moderate - Transiet organ failure (<48hours) - Local or systemic complications Severe Persistant organ failure >48 hours

Answer 11

Ransons 84% sens and 90% spec for severity of pancreatitis, 100% sens and 77% spec for mortality (best) APACHE 2 (ICU) Model 70% sens and 72% spec for severity of pancreatitis, 100% sens and 66% spec for mortality CTSI (CT findings) Model 86% sens and 71% spec for severity of pancreatitis, 100% sens and 59% spec for mortality BISAP (bedside index) Model 38% sens and 92% spec for severity of pancreatitis, 57% sens and 88% spec for mortality

Answer 12

``` AT admission Age> 55 WBC >16 Glucose >11.1 AST >250 LDH 350 ``` At 48 hours - haemtocrit drop >10% - BUN rise >1.79mmol - Calcium <2mmol - Pao2 <60mmhg - Base deficit >4mg/dl - Fluid needs >6litres 1-2 points at admission is 1% mortality 2-4 15% mortality 5 40% mortality

Answer 13

Mainly supportive Voume replacement in the first 24 hours is improtant and reduces SIRS and organ failure at 72 hours. Fluid should be targeted at reducing hypotension and haemoconcentration and preserving urine output. Hartmans is probably the preferred choice to reduce hyperchloremic acidosis Haematocrit, BUN and creatanine can be surragate markers of effective fluid resus Hypocalcaemia is usually due to low albumin and should not be corrected unless the ionized calcium is low or there is neurlogical signs of low calcium (chvosteks (face twitch) or trosseau's sign (blood pressure hand)) If hypomag present fix this and it may fix the hypoca Hyperglycaemia occurs due to reduced insulin production and patient may need this supplemented Analgesia as needed Dont with-hold enteral feeds as this has detrimental effects including GIT mucosal atrophy and permeabiity and amplifies bacterial overgrowth and translocation of gut floura. In mild cases can take PO in moderate to severe NG or NJ feeding. Low fat solid diet is as safe as clear fluids Antibiotics are not routinely reccomended and should only be used for infected necrotizing pancreatitis or extrapancreatic infections such as cholangitis and bacteraemia. IF indicated a quinalone such as cipro and metronidazole or a single carbapenum are indicated due to coverage and pancreatic tissue penetration ERCP is indicated in patient with cholangitis or an obstructed stone within 24 hours of admission. Due to the complications of ERCP it should not be performed unless the above are indicated (bilirbuin, jaundice, signs of sepsis). Dilated CBD on CT itself is not an indication need MRCP or Ultrasound in these cases Acute surgery rarely indicated- cholecystitis once disease passed if due to stone, necrosis is not operated on until four weeks when is walled off Early ERCP is indicated for patient with cholangitis or bilir

Answer 14

Presents with either prolonged recurrent abdominal pain, signs of local complciations such as bowel obstruction or thrombosis or signs of pancreatic endocrine or exocrine dysfucntion (hyperglycaemia, steatorrhoea, malasopriton) Nature of pain is similar to acute. It has been proposed that as disease progresses pain reduces due to reduced number of funcitonal acinar cells DDX same as acute

Answer 15

Made with either CT, MRCP or EUS. Serum lipase and amylase may not rise as they normally do. Hypocalcamiea and hyoalbuminemia are comm as is hyperglycaemia

Answer 16

Mainly supportive -- preferred analgesia are paracetamol and NSAIDs +- opiod if needed If above fails various other option including oral enzyme rpalcement, octreotide, antioxidants and celiac plexus block. Referral to pain specialist early may be beneficial

Answer 17

Particulalry lethal as often goes undetected until the later stages. Survival rate is less than 10% with only about 5% surviving 5 years from the time of diagnosis. Most deaths are related to metatstatic diseaer Ampullary masses which make up a small percentage of cases are associated with a better prognosis because they tend to cause obstruction and are found earlier. Also 50% amneable to resection Typical clincial features includinf abodminla pina, back pain, anorexia, nausea, weight loss and weakness. Tumours may cause obstruction leading to cholestasis, jaundice and pancreatitis. Surgical resection can be curative but otherwise treatment is palliative.

Answer 18

Extrinsic - post-operative adhesions - hernia - volvulus - compressing massess (tumor, haematoma, abscess) Intrinsic - Primary neoplasms - Inflammatory (chrons disease) - Infectious - Traumatic - intraluminal - bezoars - foreign bodies - gallstones - ascaris infection

Answer 19

Obstruction at two points caused impaired bloods supply both proximally and distally- usually seen when twist in the mesentery are seen, or in the case of an internal hernia when a loop of bowel is trapped inside a defect in the mesentary

Answer 20

Occur in the absence of physical blockage Causes of adynamic ileus - metabolic (hypokalamemia) - medications (opiates - Infection - Abdonimal trauma - laparotomy Clinical features - vomiting rarely present in ileus - marked in obstrcution - bowel sounds decreased in ileus - tinking and increased in obstruction - dehydration not prominent - prominent in bowel obstruction - bowel upper normal in ileus - distended in bowel obstruction - US decreased peristalisis, back and forth on US

Answer 21

Interrupiton of normal flow thorugh the intestinal lumen triggers a cascade of physiological changes that correlate to the progressive development of symptoms. In the presence of mechanical obstruction the proximal bowel becomes dilated by the accumulation of food stuffs and intestinal secretions. Increased intetinal dilation causes an increase in peristalsis thorughout the intestines which can trigger frequent loose bowel movement in the early phases of the obstruciton. AS the process continues further wall oedema leads to loss of normal absorptive function leading to futher accumulation of contents on the intestinal lumen. Bacerital overgrowth begins to occur, IT is this overgorwht of bacteria in a portion of the bowel taht is usually sterile which explains the faeculent nature of the vomiting. As obsruction continus there is a transudative fluid loss into the peritoneal cavity leading to worsening hypovolaemia and dehydration. In addition constant bouts of emesis can lead to electrolyte abnormalities, metabolic alkalsos severe hypovolaemia and shock.

Answer 22

In a closed loop obstruction the increase in intraluminal pressure occurs much more rapidly. Intestinal venous congestion and then arterial obstruction can also progress quickly to intestinal ischaemia and infarction. If not promptly relieved necrosis and intestinal perforation can occur.

Answer 23

1) Adhesions -- occur in 93-`100% of people with previous abdominal surgery and 25% of these will have a SBO 2) Tumors 3) Hernias- similar to their relative frequency in general ventral and inguinal hernias are encounted most but femoral, para stomal, lateral ventral and internal hernias may all be encountered -- Internal hernias are much more commonly seen with gastric bypass and up to 5% patient with Roux-en-Y will develop these

Answer 24

Rare but important cause of SBO. Occurs in 1-4% of cases usually seen in the elderly with bilary enteric fistula formation. The formation of the fistula is often seen in inflammatory conditions such as cholecystitis As the stone enters and trafvers the small bowel it often grows in size as bowel sediment is attached to it Eventually the gallstone gets lodged usually in the Ileum the narrowest portion of the small bowel

Answer 25

Infrequent but is potentially catastrophic. 3-6% of SBO cases in the west much more common in afriva india and the middle east. Primary volvulus occurs in an otherwise normal abdominal cavity, secondary occurs when congential or acquired abnormality leads to the develpoement. Always close loop

Answer 26

Crampy abdominal pain, abdominal distenstion, nasuea and vomiting, constipation and/or the inability to pass flatus. Pain is often described in the peri-umbilical region and typically has a crescendo decresecndo pattern. Distal obstruction typically cause symptoms over a slower period of 1-2 days and are frequently accompanied by a greater abdominal distention The colon requires 24 hours to empty after the formation of a SBO and thus faltus and stool can continue for this period even with full osbturciton, Examination - Vitals and hydration status - abdominal exam for distention and hernias - Bowel sounds are described as high pitched and tinling in nature studies have also found decreased or absent sounds. - Peritonitis usually indicates late obstructive complicationsn

Answer 27

Bloods for dehydration and lactate AXR - diagnosistic in only 50-60% of acses, equivocal in 20-30% and normal, nonspecific or misleading in 10-20% of cases CT - high degree of sensitivity and specific -- will pcik up strangulation which AXR will not US becoming a diagnositic tool with increasing sensitivties of probes

Answer 28

Resus NG for decompression -- little effect in duration fo SBO. Can delay NG if vomiting can be contolled with antiemetics SBO merit admission universally. Simple SBOs related to adhesions will resolve with conservative treatement in the next 48-72 hours

Answer 29

Involves the sudden reduction or loss of blood flow to the small bowel and may involve the right colon. THe left colon has a much greater supply of collateral and is not as commonly involved Needs to be diffentiated from chronic mesneteric ischaemia "gut angina"In which there is recurrent episodes of abdominal pain post prandially when there is an increase in o2 demand There are four main aetiologies of mesenteric ischaemia 1) arterial mesenteric emboli -- most common 2) aterial mesenteric thrombos 3) Non occulsive mesenteric ischemia 4) Venous thrombosis

Answer 30

Mesenteric vessels arise from the primitive vental segmental arteries. THese become the coeliac trunk, SMA and IMA The ceoliac trunk arises anteriorly from the aorta. It gives rise to the splenic, hepatic and left gastric and supplies the distal oesophagus to the middle of the duodenum THe SMA arises 1 cm inferior from the trunk and supplies the rest of the duodenum to the mid of the transverse colon THe IMA arises 6-7 cm below the SMA and supplies the distal third of the transverse to the anus Intetinal blood flow accounts for 25% of CO increasing to 35% postprandially. OF this 70% supplies the mucosa. Given the high demand for O2 damage is seen quickly with ischaemia structural damage to the intestinal villi cna be observed within 15 minutes and sloughing occurs at 3 hours. ^hours transmural necoriss is complete. COmplicated this process is a any re-establishments of blood flow at this point will lead to signifiant repulsion injury

Answer 31

Most common cause of AMI accounting for approximately 50% of cases. The median age of patients is 70 and two third are women. Most common source of emboli are left artrial or ventricular mural thrombos or valvular lesions. AF is only responsible for 0.14% of cases compared to 2.3% of CVA SMA is the most common vessle to be involved as it is the largest calbire. MOst commonly lodge 3-10cm distal to the origin

Answer 32

Results from progressive atherosclerotic disease. Same risk factors for normal athero. Usually will have a history suggestive of chronic mesenteric ischaemia

Answer 33

Occurs as a result of mesenteric vasospasms in the absence of physical obstruction. This vasospasm is tirggered by mesenteric hypoperfusion or excessive sympathetic activity. Hypoperfusion can be caused by a number of condition - sepsis - severe dehydartion - pancreaitis and third spacing - haemorrhagic shock Excessive sympathetic drive - CCF - Drugs such as vasopressors, cocaine or digoxin Once intiated the vasospasm tends to continue even when the initiating insult has been addressed leading to intermittent ischaemia and reperfusion thought to be more deleterious than a prolonged ischaemia

Answer 34

Least common cause of AMI accounting for only 5-15% of cases. Usually involved the SMA vein and its branches The majority are underlying inherited thombotic disease or inhierited or acquried hypercoagubale state Factor V leidon is the mot common cause

Answer 35

Hypercoaguable states - Factor V - Polycythemia vera - Sickle cell disease - antithrmobin 3 - protein c or s defiency - malignancy - myeloproliferative disorders - OCP - Pregnancy Inflammatory condition - Pancreatitis - diverticulitis - appendicitis - cholangitis Trauma - Operative venous injury - post splenectomy - Blunt or abdominal truama Miscellaneous - CCF - Renal failure - Decompression sickness - portal hypertension

Answer 36

THe classic history is of Sudden onset of poorly localized abdominal pain, gastric emptying (vomiting or diarrhoea) in a patient with known cardiac disease In cases of venous thrombosis the symptoms are slower in onset and often have been present for several days by the time the patient seeks medical attention. 50% of patient that have an acute embolic event have a personal history of thromboembolic disease The pain to exam is described as being out of proportion to the physical examination findings. THe patient may be writhing in pain but have a soft abdomen, As the parietal peritoneum becomes involved the abdominal finding progess. Hypotension tachycardia and tachypnoea are all signs of severe ischaemia and have a poor prognosis

Answer 37

``` AAA Perforated viscous bowel obstruction biliary disease atypical MI ```

Answer 38

Non specific findings on labs- d-dimer, lactate and interleukin 6 have been described as biomarkers. Serial lactate probs best Plain AXR are usually non specific Mesenteric angiography is the gold standrd and offer the benefit that diagnosis and intitial treatment can occur concurrently CTA is the most common IX as angiography suites are not commonly available DUplex US is very specific 92-100% but its sensitivity is reduced by limited evaluation beyond the proximal main vessel.

Answer 39

--Aim of treatment is to restore blood flow as soon as possible., manage the underlying condition and reduce vasospasms. --Initially fluid resus and HD stability. If pressors are required in these patient dobutamine, dopamine or milrinone are recommeneded as they have the least vasoconstrictive effect on the mesenteric vasculature. --Cover with IVABs if evidence of infarct peroration or peritonitis - triples ' --Pain management --Urgent laportomy +- preoperative conventional angiography may be beneficial to attempt rapid revascularization. --Papaverine a phosphodiesterase inhibitor may be infused directly into the effected vessels via angiography. THis results in elevated CAMP which results in profound smooth muscle relaxation. --IV heparin should be administered to prevent thrombosis in vasospastic vessels. In mesenteric venous thrombosis heparin infusion may be sufficient by itself

Answer 40

Supported by three muscle groups , levator ani and the internal and external sphincters Bloods supply is via the inferior, middle and superior haemorrhoidal arteries which arise from the inferior mesenteric, internal iliac and internal pudendal arteries Lymphatic drainage is to the inferior mesenteric nodes superior to the dentate line and to the inguinal region below Involuntary sphincter is supplied via parasympathetic nerves from the S2-4 nerve route. Volunatary control of the external is via nerve roots from s2-3

Answer 41

Occur when the three anal vascular submucosal cushions become engorged. Blood supply is from the arterial system leading to bright red blood. Haemarhoids are not varicose veins, they are normal structures that manifest symptoms whne the muscularis submucosa weakens and the cushions are displaced. Bleeding is the chief complaint, and unless the haemorrhoid is thrombosed it is usually painless. Blood on toilet paper is usually due to fissure or external haemorrhoid, dripping into the bowl is from internal, can have mucoid discharge, mixed with stool is from higher in the GIT than the anus and melena from the upper GIT

Answer 42

External - inferior to the haemorrhoidal plexus, proximal to the dentate line - modified squamous Internal superior to the haemorrhoidal plexus, distal to the dentate line - transitional or colunar Mixed

Answer 43

First degree -- nil prolapse, medical treatment Second degree - prolapse during defecations, medical treatment Third degree - spont prolapse or during defecation, manual reduction, can be treated medically or surgical repair Fourth degree- permanent - irreducible, require surgical repair

Answer 44

Thrombosed external -- excision in emergency department -- can be complicated by rebleeding, swelling and formation of skin tags -- resolves spontaneously within 72 hours not often done Second and third degree internal - electival surgical repair, banding, sclerotherapy, haemorrhoidectomy Fourth degree non thrombosed - nonurgent haemorrhoidectomy Fourth degree thrombosed or gangrenous -- emergent haemorrhoidectomty

Answer 45

Nonthrombosed external and non prolpasing internal use WASH (warm water, analgesics, stool softener, and high fibre diet) Anal canal pressure reduces in warm water Second and third degree internal haemorrhoids WASH but may need surgery Thrombosed and gangrenous fourth degree haemorrhoid require surgical intervention

Answer 46

Most common cause of painful rectal bleeding of sudden onset. Most commonly encountered anorectal problem in children. Most occur along the posterior midline where the skeltal muscle fibers that encircle the anus are the weakest. patient report sudden searing pain during defecation accompanied by a small amount of bright red blood in the stool or on the toilet paper. This is followed by a nagging burning sensation cuased by internal sphincter spasm. Subsequent bowel motion are excruciating MX - WASH protocol - GTN ointment BID - Nifedipine gel - Surgical excition ] - Anal dilation performed with the patient under general anaethesia

Answer 47

Can occur in otherwise healthy adults when the mucous producing glands at the base of the anal crypts occlude - can be a herald of IBD, trauma, cancer, rdation or infection Common organisms include (e.coli, staph, bacteroides, strep, proteus Natural disease progression is to fistula formation in the body's attempt to drain the infection spontaneously Some can be mangemed in the ED however all anorectal abcesses have been associated with fistulae formation and definitive treatment of the fistula network at the time of I&D is needed for resolution

Answer 48

Account for 40-45% of anorectal abscesses. They produce painful swelling at the anal verge worsened on sitting and defecation. Most paitent are afebrile and have localized tenderness eryhtema swellign and fluctuance. ED management with i&D is possible if patient is able to tolerate the procedure and they have nil co-morbidities. WASH protocal

Answer 49

20-25% of abcesses form outside the pshncter muscles in the buttocks, patient usually present with severe pain. Most require surgical intervention

Answer 50

25% of abcess from in the space deep to the external sphincter and inferior to the levator ani. The infection tracks cephalad and may appear to be a mass in the rectum. Report continous rectal pressure and throbbing pain on sitting and defecation. They may have fever and leukocytosis. Inguinal lymp0hadenopathy are common May be associated with fistulae formation

Answer 51

rare accounting for less than 5% of abcess they cause perianal and buttock pain associated with fever and leukocytosis. External evidence is usually absent which often delays the diagnosis. Many patient are obese or have diabetes, IBD, PID or diverticulitis.

Answer 52

Abcesses containing hair and pus in the lidline of the sacrococygeal area afflict young adults with a 4:1 male predominance and are more common in obese and hirsute people Treatment ranges from aspiration to full surgical debridement - aspiration and AB with surgical OPD in week may promote faster healing than I&d

Answer 53

is an infection of the apocrine glands. It is most common in young adults and is associated with poor skin hygiene, hyperhidrosis, obesity, acne, DM and smokling. Occluded glands may be infected with strains of staph, strep, e.coli or proteus. Extension through the dermis spreads the infection to neighboring ducts and a network of sinus tracts, leading to extensive scarring. Found in the perianal region + axillae Treatment begins with careful attention to hygiene warm compresses, ABs (cefalexin) and dietary modifications (avoidance of dairy products and foods with high GI)

Answer 54

1) appendicieal obstruction prevents egress of mcuous and bacteria from the appendix 2) continued mcuous proudction and bacterial proliferation result in luminal distension which stimulates the T10 visceral afferent nerves creating periumbilical pain typically lasting 4-6 hours 3) intraluminal pressure eventually exceeds local cappillary pressure in the appendiceal wall preventing arterial perfusion and resulting in tissue ishcemia and inflamamtion 4) this causes trans-murral inflammation that extends into the surrounding tissues resulting in somatic localised pain typically focaused in the right lower quadrant. Causes of obstruction - faecolith most common - appendicoliths - lymphoid hyperplasia

Answer 55

Very rare | results from inflammation of the appendiceal remnant that may persist after the appendix has been removed surgically.

Answer 56

Moderately useful - RLQ pain - migration of pain - presence of pain prior to vomiting - no history of similar pain Mildly usfule - vomting - male gender - pain worsened when driving over speed bumps Not useful - anorexia - nauea - pain worse with cough or movementb

Answer 57

Useful - RLQ tenderness - abdominal wall rigidity - Mcburneys point Mild - Reboudn tenderness - garding - temperature >38.3 - percussion tenderness - psoas sign Psoas sign - increased abdominal pain with patient lying on left side while provider passively extends the patietns right leg at the hip with both knees extended -Sens 42% spec 79-95% Rovsigns - abdominal pain in the RLQ while palpating the lower left Sens 7% and spec 58-96% Obturator sign - increased abdominal pain in the supin patients as the provider internally and externally rotates the right leg as it is flexed at the hip sens 8% and spec 94%

Answer 58

WBC - CRP - Combined raised CRP and WBC has an Postive likelihood ratio of 23 and a -ve ratio of 0.03 Urinalysis - pyruis, haematuria and/or bacteria in up to 48% of patients with appendicitis Graded compression utrasound (sens 75-90%, spec 83-95%) - criteria include - Require appendiceal diamter >6-7mm and noncompressible appendix - fat stranding and peritoneal fluid CT (sens 94-100% and spec 91-99%) - Appendiceal diameter >6 with surrounding inflammation or >7 without - Appendiceal circufmernetial wall thickening >2mm with mural enhancement - calcified appendicolith - signs of periappendical inflammation

Answer 59

- Triple antibiotics or piptaz if perfed - Perforated or complicated appendicits (those with abscess formation) should be treated with either lap removal or percutaneous drainage - For non complicated appendicitis conservative management with supportive care and antibiotics can be considered Conservative treatment has risk of failure or need recurrent appendicitis. This is countered by a negative appendectomy rate of 3.6-10% and a complication rate as high as 18% including SBO, adhesions surgical site infection and abscess formation

GIT Flashcards

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