Zusammenfassung der Ressource
Acute appendicitis
- Epidemiology
- 10%
population will
develop it
- Commonest
between 10 and
20.
- Uncommon before 2 years
- A normal appendix is
removed at 10-20% of
appendicectomies.
- Pathophysiology
- An obstructed
system gets
infected.
Anmerkungen:
- Cholangitis and pyelonephritis are similar in this respect.
- Faecolith or enlarged piece of
lymphoid tissue ? response to
viral illness.
- Much rarer
causes are caecal
cancer and
carcinoid tumours
- Clinical features
- Initially
colicky
midgut pain
- Peritonitic pain as
the inflammation
spreads to involve
the parietal
peritoneum.
- Associated
with fever,
anorexia,
N+V
- Pain before the
vomiting usually.
Constipation
rather than D
- Abdo tenderness,
guarding, rebound and
percussion tenderness.
- Rovsing's sign positive
Anmerkungen:
- Palpation of the left iliac fossa makes the pain worse as the peritoneum is being stretched.
- Tenderness on digital
rectal exam.
- Inflammatory fluids,
maybe pus tracked
into the pouch of
Douglas.
- Psoas sign
Anmerkungen:
- Pain on extending the hip
- Retrocaecal appendix
- Cope sign
Anmerkungen:
- Pain on flexion and int flexion of R hip
- Appendix in close
relation to obturator
internus
- Appendix mass
- Walled off by the
omentum and small
bowel, and then
presents.
Anmerkungen:
- Usually occurs 72 after the inflammation begins/onset of symptoms.
- Palpable mass
- Gets better with Abx, or
abscess that requires
drainage.
- Elective
appendicectomy
3 months later
(Ochsner-Sherren
regimen).
Anmerkungen:
- 20% may develop recurrent appendicitis otherwise.
- Operation details
Anmerkungen:
- Need to know the basic operation.
- Differential diagnosis
- RIF mass
- Appendix mass
- Gynae mass - ovarian cyst
- Caecal cancer
- Soft tissue tumour e.g. sarcoma
- LN mass
- TB
- Actinomycoses
- Transplant kidney
- Iliac aneurysm
- RIF pain
- Ectopic pregnancy
- Acute appendicitis
- PID
- Ovarian cyst
- Perforated PU
- Meckel's
- UTI
- Ureteric colic
- Mesenteric adenitis
- Crohn's disease
- Caecal cancer
- Periumbilical (colicky pain)
- SBO
- Early appendicitis
- Ischaemic bowel
- Mesenteric adenitis
- Pancreatitis
- Investigations
- CT scan
- Decreases
false negative
operation rate,
but increases
delay