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193558
Acute appendicitis
Descripción
Surgical Talk Mapa Mental sobre Acute appendicitis, creado por kavi el 05/09/2013.
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surgical talk
surgical talk
Mapa Mental por
kavi
, actualizado hace más de 1 año
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Creado por
kavi
hace casi 11 años
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Resumen del Recurso
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.
Nota:
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
Nota:
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
Nota:
Pain on extending the hip
Retrocaecal appendix
Cope sign
Nota:
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.
Nota:
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).
Nota:
20% may develop recurrent appendicitis otherwise.
Operation details
Nota:
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
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