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Description
Flashcards by Ashutosh Kumar, updated more than 1 year ago
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Created by Ashutosh Kumar
almost 7 years ago
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| Question | Answer |
| Appendicitis: Pathophysiology in adults vs children: | Pathogenesis: Luminal obstruction causing bacterial overgrowth which leads to inflammation/swelling and therefore increase pressure, which then obstructs arterial supply resulting in localized ischaemia, gangrene/perforation and localized abscess (walled off by omentum) or peritonitis. In children or young adults obstruction is caused by hyperplasia of lymphoid follicles initiated by infection whereas in adults it is usually caused by a fecalith. |
| Appendicitis clinical features: | Clinical features: Most reliable feature is the progression of signs and symptoms Low grade fever which rises with perforation Abdominal pain and then anorexia, nausea and vomiting. Classical pattern: Pain initially periumbilical; constant, dull, poorly localised, then well localized pain over McBurney’s point. This is due to progression of the disease from visceral irritation (causing referred pain from structures of the embryonic midgut, including the appendix) to irritation of parietal structures. Inferior appendix McBurney’s sign (tenderness ⅓ the distance from the ASIS to the umbilicus on the right side); present whenever the opening of the appendix is directly under McBurney’s point; therefore, McBurney’s sign is present even when the appendix is in different locations. Rovsing’s sign (palpation pressure to left abdomen causes McBurney’s point tenderness) Retrocecal appendix: Psoas sign (pain on flexion of the hip against resistance or passive hyperextension of hip) Pelvic appendix: Obturator sign (flexion then external or internal rotation about right hip causes pain) |
| Appendicitis Dx: | 1. Alvarado score (MANTRELS) (Migratory pain, Anorexia, Nausea, Tenderness RLQ, Rebound tenderness, Elevated temperature, Leukocytosis, shift of WBC to left) 1-4 discharge, 5-6 observe, 7-10 surgery 2. Pregnancy test to rule out ectopic 3. Urinalysis 4. U/S to rule in but not out 5. CT most optimal |
| Appendicitis treatment: | Treatment: Appendectomy Cefazolin and metronidazole as perioperative antibiotics in uncomplicated. Some support for antibiotic only treatment in uncomplicated. |
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