#Phase 2.1: Peri Op > Acute Appendicitis > Flashcards

Acute Appendicitis Flashcards

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1
Q

When is the highest incidence age range for Acute Appendicitis?

A

10-20 years

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2
Q

What is the pathophysiology of Acute Appendicitis?

A

Acute inflamm of appendix bc obstruction of lumen bc:

  1. Faecolith
  2. Impacted (stuck) stool
  3. Lymphoid hyperplasia
  4. Tumour (rare)
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3
Q

What is a faecolith?

A

Hard stony mass of faeces

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4
Q

What is the most common cause of Acute Appendicitis in adults?

A

Faecolith

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5
Q

Why is impacted (stuck) stool a more common cause of Acute Appendicitis in children?

A

Higher rates of constipation

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6
Q

What is a lymphoid hyperplasia?

A

Hyperplasia of the submucosal lymphoid follicles

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7
Q

What is the most common cause of Acute Appendicitis in children?

A

Lymphoid hyperplasia

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8
Q

What is the most common cause of lymphoid hyperplasia?

A

Viral infection

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9
Q

How does lumen obstruction lead to appendicitis and eventually peritonitis? (8 steps)

A
  1. Lumen obstruction
  2. Lumen fills with mucus
  3. Increased intraluminal pressure
  4. Reduced blood flow to appendix
  5. Resident bacteria in appendix multiply (B.fragilis and E.coli)
  6. Inflamm + ischaemia of appendix (appendicitis)
  7. Perforation
  8. Peritonitis
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10
Q

What is the most common presentation of Acute Appendicitis?

A

Abdominal pain

Starts off as dull + poorly-localised peri-umbilical / epigastric pain –> sharper + migrates to RIF within 1-12 hours

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11
Q

Is the abdominal pain in Acute Appendicitis worse on movement?

A

Yeah

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12
Q

What clinical features can you find on examination of a patient of Acute Appendicitis? (3 things)

A
  1. Rebound tenderness
  2. Guarding
  3. Percussion pain

@ McBurney’s Point (2/3 of way between umbilicus & ant. sup. iliac spine)

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13
Q

What clinical features can be seen in SEVERE cases of Acute Appendicitis?

A

Sepsis features

  1. Tachycardia
  2. Hypotension
  3. Appendiceal abcess + RIF mass
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14
Q

What are the specific signs of Acute Appendicitis on examination? (2 things)

A
  1. Rovsing’s Sign
  2. Psoas Sign
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15
Q

What is Rovsing’s Sign?

A

RIF pain @ palpation of LIF

(sign of acute appendicitis)

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16
Q

What is Psoas Sign?

A

RIF pain @ extension of right hip

(sign of acute appendicitis)

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17
Q

What does the Psoas Sign suggest?

A

Inflam appendix touching psoas major muscle in retrocaecal position

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18
Q

What symptoms of Acute Appendicitis can present AFTER the pain?

A
  1. Nausea + vomiting
  2. Anorexia
  3. Low grade fever
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19
Q

If you suspect Acute Appendicitis and patient has HIGH grade fever, what’s up den?

A

It’s probs Peritonitis or stn else cah Acute Appendicitis only has LOW grade fever

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20
Q

What lab investigations should be done for suspected Acute Appendicitis?

A
  1. FBC = reveals neutrophil leucocytosis in 80-90% of cases
  2. CRP = elevated
  3. Urinalysis = to exclude UTI
  4. Pregnancy test = to exclude pregnancy / ectopic pregnancy
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21
Q

Is imaging required for Acute Appendicitis diagnosis?

A

No but useful if other tests inconclusive

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22
Q

What imaging should be done Acute Appendicitis?

A
  1. CT
  2. US
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23
Q

Why is a CT scan useful in Acute Appendicits? (2 things)

A
  1. 94% sensitivity + 95% specificity in acute appendicitis diagnosis
  2. Minimises likelihood of -ve appendicectomy
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24
Q

What is -ve appendicectomy?

A

Appendicectomy in which surgeon discovers there is NO appendicitis

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25
Why is an US scan useful in Acute Appendicits? (2 things)
1. Good first line imaging if radiation is concern (e.g children / pregnant) 2. Good if suspected gynaecological differentials
26
What gynaecological conditions present similarly to Acute Appendicitis? (3 things)
1. Ectopic pregnancy 2. Ovarian torsion 3. Pelvic inflamm disease
27
What are the SIMILARITIES between Acute Appendicitis and Ectopic pregnancy? (3 things)
1. RIF pain 2. Nausea + vomiting 3. Fever
28
How do you DIFFERENTIATE between Acute Appendicitis and Ectopic pregnancy? (2 things)
1. Ectopic = present w 6-8 wk history of amenorrhoea (absence of periods) +/- vaginal bleeding 2. Ectopic = +ve pregnancy test 3. US scan
29
What are the SIMILARITIES between Acute Appendicitis and Ovarian torsion? (2 things)
1. 1. RIF pain 2. Nausea + vomiting
30
How do you DIFFERENTIATE between Acute Appendicitis and Ovarian torsion? (2 things)
1. Ovarian torsion = palpable adnexal mass (ovary region) in 50-70% cases 2. US scan
31
What are the SIMILARITIES between Acute Appendicitis and Pelvic inflamm disease? (3 things)
1. Lower abdominal pain 2. Nausea + vomiting 3. Fever
32
How do you DIFFERENTIATE between Acute Appendicitis and Pelvic inflamm disease? (3 things)
1. Pelvic inflamm disease = bilateral 2. Pelvic inflamm disease = vaginal / cervical discharge 3. Pelvic inflamm disease = cervical motion tenderness @ examination 4. US scan
33
What GI conditions present similarly to Acute Appendicitis? (4 things)
1. Acute mesenteric adenitis (children) 2. Meckel’s diverticulitis 3. Inflammatory bowel disease (Crohn’s) 4. Acute cholecystitis
34
What are the SIMILARITIES between Acute Appendicitis and Acute mesenteric adenitis? (2 things)
1. Lower abdominal pain 2. Guarding
35
How do you DIFFERENTIATE between Acute Appendicitis and Acute mesenteric adenitis? (2 things)
1. Acute mesenteric adenitis = occurs in children after upper resp tract infection 2. Acute mesenteric adenitis = does NOT cause localised tenderness
36
What are the SIMILARITIES between Acute Appendicitis and Meckel’s diverticulitis? (2 things)
1. Periumbilical pain --\> localises to RIF 2. Peritonitis
37
How do you DIFFERENTIATE between Acute Appendicitis and Meckel’s diverticulitis?
Indistinguishable from each other, only identified once you get a -ve appendicectomy
38
What are the SIMILARITIES between Acute Appendicitis and Inflammatory bowel disease (Crohn’s)? (5 things)
1. Present in young adults 2. RLQ pain 3. Fever 4. Nausea + vomiting 5. Raised inflamm markers
39
How do you DIFFERENTIATE between Acute Appendicitis and Inflammatory bowel disease (Crohn’s)? (2 things)
1. Crohn's = chronic diarrhoea 2. Crohn's = maybe +ve FHx
40
What are the SIMILARITIES between Acute Appendicitis and Acute cholecystitis? (2 things)
1. Right-sided abdominal pain (+/e guarding) 2. Raised inflamm markers
41
How do you DIFFERENTIATE between Acute Appendicitis and Acute cholecystitis? (2 things)
1. Acute cholecystitis = pain in RUQ 2. Palpable gallbladder
42
What Urological conditions present similarly to Acute Appendicitis? (3 things)
1. Testicular torsion 2. Ureteric stones (right) 3. UTI
43
What are the SIMILARITIES between Acute Appendicitis and Testicular torsion? (3 things)
1. Abdominal pain 2. Nausea / vomiting 3. Presents in children + young adults Differences: in testicular torsion, there is typically severe testicular pain and testicular oedema
44
How do you DIFFERENTIATE between Acute Appendicitis and Testicular torsion? (2 things)
1. Testicular torsion = severe testicular pain 2. Testicular torsion = testicular oedema
45
What are the SIMILARITIES between Acute Appendicitis and Ureteric stones (right)? (2 things)
1. Right sided abdominal pain 2. Nausea / vomiting
46
How do you DIFFERENTIATE between Acute Appendicitis and Ureteric stones (right)?
Ureteric stones = pain in flank, colicky, radiates to groin
47
What are the SIMILARITIES between Acute Appendicitis and a UTI? (2 things)
1. Lower abdominal pain 2. Fever
48
How do you DIFFERENTIATE between Acute Appendicitis and a UTI? (2 things)
1. UTI = Dysuria, urgency, frequency 2. UTI = older adults
49
What is the gold standard treatment for Acute Appendicitis?
Laparoscopic appendicectomy
50
What should patients receive 1 hour prior to Laparoscopic appendicectomy? What does this do?
Prophylactic abx (piperacillin / tazobactam) Reduces wound infections
51
What should happen to the appendix after Laparoscopic appendicectomy.
Sent for histopathology to rule out malignancy (found in 1% cases)
52
How should a patient with a perforated appendix be managed? (2 things)
1. Urgent appendicectomy 2. Post-op abx
53
How should patients with Acute Appendicitis who are unfit for surgery be managed? (3 things)
1. Analgesia 2. IV Fluids 3. IV abx
54
What are the complications of Acute Appendicitis? (4 things)
1. Perforation (most common) 2. Surgical wound infection 3. Appendix mass 4. Appendix abcess
55
Why is perforation a more common complication in young children?
Delayed presentation
56
What cause of Acute Appendicitis increases the risk of perforation?
Faecolith (hard stony mass of faeces)
57
What reduces the risk of Surgical wound infection in Acute Appendicitis?
If surgery done laparoscopically instead of open
58
What is an Appendix Mass?
When omentum + small bowel adhere to appendix
59
How does an Appendix Mass present?
Tender mass in RIF
60
How is an Appendix Mass diagnosed?
US / CT
61
How should an Appendix Mass be managed? (2 things)
1. Early surgery 2. Conservatively - NBM / abx
62
What should be excluded when an Appendix Mass is suspected?
Colonic tumour (by laparotomy / colonscopy)
63
What causes an Appendix Abscess? (2 things)
1. Perforated appendix 2. Unresolved Appendix Mass that enlarges
64
How does an Appendix Abscess present? (3 things)
1. Palpable RIF mass (tender) 2. Fever 3. Leucocytosis
65
How should an Appendix Abscess be managed? (2 things)
1. Drainage (surgical / percutaneous) (CT / US guided) 2. Abx
#Phase 2.1: Peri Op
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