acute appendicitis

Question 1

RIF pain differential diagnosis:

Answer 1

• Acute appendicitis
• Terminal Ileitis
• Meckel’s Diverticulum
• Urinary tract infection/pyelonephritis
• Renal / Ureteric colic
• Ectopic pregnancy
• Salpingitis
• Ovarian mass

Question 2

1- investigations to perform :
2- URINE
* Microscopy - < — pus cells
* Culture - mixed growth E-coli and Staphylococcus
* Colony count - < 100,000 organisms/ml
* What is the significance of these urine findings?
* Why is it not a UTI?

Answer 2

1-
* FBC - especially WCC and differential – why WCC?
* MSU - C/S and microscopy
 Why?
 For what?
* Pregnancy Test
* + Pl. Abdomen X-ray – why?
* + Ultrasound abdomen – why?
5

Question 3

What is the predominant inflammatory cell
in acute appendicitis?

Answer 3

neutrophils

Question 4

WHAT IS THE ROLE OF THE POLYMORPH
IN THE INFLAMMATORY PROCESS?
* —
* — :
 — radicals
 — peroxide
What other cells in the
body are phagocytic?

Answer 4

phagocytosis
killing
superoxide
hydrogen

Question 5

OUTCOME - ACUTE INFLAMMATION
* Complete —
 Rare in acute appendicitis
* —- inflammation
* —
* —

Answer 5

resolution
chronic inflammation
abscess
fibrosis
info:
MANAGEMENT OF THIS PATIENT
* Prepare for Surgery
* Appendicectomy by open surgery or laparoscopy
* Role of prophylactic antibiotics

Question 6

What are the causes of
acute appendicitis?
* 98% due to inflammation of the — of the appendix by
organisms native to —.
What precipitates the infection?

Answer 6

wall
bowel

Question 7

IMPORTANT PRINCIPLE
* Obstruction to the lumen by a — causes
 —
 Bacterial —
 —
 —
 Reduced — and sometimes —-
* Sometimes obstruction may be due to — of the appendix lumen due to other causes examples.

Answer 7

faecolith
stasis
bacterial proliferation
inflammation
oedema
blood supply
gangrene
stenosis

Question 8

other causes od acute appendicitis :

Answer 8

• Other causes of acute appendicitis:
   Crohn’s disease
   Yersinia
   TB
   Measles

Question 9

COMPLICATIONS OF ACUTE APPENDICITIS
* — transformation
* — , —
* —
*—

Answer 9

gangrenous
perforation , peritonitis
abscess
Septicaemia

Question 10

• Localised collection of pus is known as —-
   Dead and degenerate —
   Dead and degenerate — tissue cells
   — fluid
   Dead —

Answer 10

abscess
leukocytes
host
oedema
dead organisms

Question 11

What does perforation of
the appendix mean?
PERFORATION
A “ – ” in the appendix allowing contents of appendix into —
* What is the clinical significance of perforation?
* Peritonitis V Perforation.
* What is the difference?
* Appendicitis can cause a localised or a generalised
peritonitis.

Answer 11

hole
peritoneum

Question 12

radiology of Abdominal Perforation
* — under the – on an — x-ray film of the
abdomen
perforated viscus:
e.g. perforated duodenal ulcer post laparoscopy, post surgery ,
peritonitis with gas forming organisms

Answer 12

air
diaphragm
errect

Question 13

SYSTEMIC EFFECTS OF INFLAMMATION
* — phase response
 Inflammatory mediators produced in response to
infection / injury
 Pyrexia
 Acute phase proteins (e.g. CRP, ESR)
 Leukocytosis
 — BP and pulse, sweating and — , sleep,
anorexia, malaise
 Severe — —> — , — and —

Answer 13

acute
increased
riggors
sepsis
DIC , hypotension , shock

Question 14

• Treatment of perforated appendicitis:
   —
  IV —

Answer 14

surgery
iv antibiotics

Question 15

Why does the pain of acute appendicitis classically
migrate from the peri-umbilical area to the RIF?:
1. Visceral pain : umbilicus and appendix innervated by
same segment — nervous system
2. Somatic pain : — and — peritoneum irritated, pain localises to RIF
In the case of retro-caecal or pelvic appendix, presentation
may not be typical

Answer 15

autonomic
serosal and parietal

Question 16

CHRONIC INFLAMMATION
* Inflammation with chronic inflammatory cells e.g. — , — cells, — .
 Progress from —-
 Ab —
 — diseases

Answer 16

lymphocytes
plasma cells
histiocytes
acute inflammation
ab initio
autoimmune

Question 17

GRANULATION TISSUE
A — RESPONSE TO INJURY
* Specialised type of tissue characteristic of —
* Characterised by proliferation of — and new thin- walled — in a — extracellular matrix with — inflammatory cells
* Progressively accumulates — tissue matrix, eventually resulting in dense —

Answer 17

nonspecific
healing
fibroblasts
capillaries
loose extracellular matrix
chronic
connective
dense fibrosis

Question 18

GRANULOMATOUS INFLAMMATION
* A — immune response or a foreign body response
* Infection (specific types)
* Foreign body (e.g. splinter, suture, keratin, hair…)
* Metal/dust
 Berylliosis
 Silicosis
* Response to tumours
* Unknown aetiology:
 —
 — disease

Answer 18

specific
sacroidosis
crohns

Question 19

GRANULOMATOUS INFLAMMATION
INFECTIOUS CAUSES
* —
 TB, Leprosy, Cat scratch disease
* —
 Histoplasmosis, Blastomycosis
* —-
 Schistosomiasis, Toxoplasmosis, Leishmaniasis
* —
 Syphilis

Answer 19

bacteria
fungi
parasites
spirochetes

Question 20

causes of granulmaus formation:
1. Infection
2. Foreign material
3. Malignancy
4. Idiopathic
5. All of the above
AETIOLOGY OF GRANULOMAS
* — response
* Type — immune reaction

Answer 20

foreign body
IV