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- What is Appendicitis Inflammation of the appendix caused by obstruc- tion of the appendiceal lumen, producing a closed loop with resultant inflammation that can lead to necrosis and perforation
- Psoas sign Pain elicited by extending the hip with the knee in full extension, seen with appendicitis and psoas inflammation
- Obturator sign Pain upon internal rotation of the leg with the hip and knee flexed; seen in patients with appendici- tis/pelvic abscess
- Rovsing's sign Palpation of the left lower quadrant resulting in pain in the right lower quadrant; seen in appen- dicitis 5. What are the causes of **appendicitis?
- What is the lifetime in-** cidence of acute ap-
Lymphoid hyperplasia, fecalith (a.k.a. appendi- colith) Rare—parasite, foreign body, tumor (e.g., carcinoid)
7%
pendicitis in the United States?
7. What is the most com- mon cause of emergent abdominal surgery in the **United States?
- How does appendicitis** **classically present?
- Why does periumbilical** **pain occur?
- Why does RLQ pain oc-** **cur?
- What are the signs/** symptoms?
Acute appendicitis
Classic chronological order: 1. Periumbilical pain (intermittent and crampy) 2. Nausea/vomiting 3. Anorexia 4. Pain migrates to RLQ (constant and intense pain), usually in 24 hours
Referred pain
Peritoneal irritation
Signs of peritoneal irritation may be present: guarding, muscle spasm, rebound tenderness, obturator and psoas signs, low-grade fever (high grade if perforation occurs), RLQ hyperesthesia
- McBurney's point Point one third from the anterior superior iliac spine to the umbilicus (often the point of maximal tenderness) 13. What is the differential di- **agnosis for: Everyone?
- What is the differential di-** agnosis for: Females?
Meckel's diverticulum, Crohn's disease, perforat- ed ulcer, pancreatitis, mesenteric lymphadeni- tis, constipation, gastroenteritis, intussusception, volvulus, tumors, UTI (e.g., cystitis), pyelonephri- tis, torsed epiploicae, cholecystitis, cecal tumor, diverticulitis (floppy sigmoid)
Ovarian cyst, ovarian torsion, tuboovarian ab- scess, mittelschmerz, pelvic inflammatory dis- ease (PID), ectopic pregnancy, ruptured pregnan- cy
- What^ is^ the^ treatment^ for nonperforated acute ap- pendicitis?
Nonperforated—prompt appendectomy (pre- vents perforation), 24 hours of antibiotics, dis- charge home usually on POD #
What is the treatment for Perforated—IV fluid resuscitation and prompt ap- perforated acute appen- pendectomy; all pus is drained with postoperative dicitis? antibiotics continued for 3 to 7 days; wound is left open in most cases of perforation after closing the fascia (heals by secondary intention or delayed primary closure)
How is an appendiceal Usually by percutaneous drainage of the ab- abscess that is di- scess, antibiotic administration, and elective ap- agnosed preoperatively pendectomy about 6 weeks later (a.k.a. interval treated? appendectomy)
If a normal appendix is Yes found upon exploration, should you take out the normal appendix?
How long after removal For 24 hours of a NONRUPTURED ap- pendix should antibiotics continue postoperative- ly?
Which antibiotic is used Anaerobic coverage: Cefoxitin®, Cefotetan®, for NONPERFORATED Unasyn®, Cipro® and Flagyl® appendicitis?
What antibiotic is used Broad-spectrum antibiotics (e.g., Amp/ for a PERFORATED ap- Cipro®/Clinda or a penicillin such as Zosyn®) pendix?
How long do you give Until the patient has a normal WBC count and antibiotics for perforated is afebrile, ambulating, and eating a regular diet appendicitis? (usually 3 - 7 days)
What is the risk of perfo- ration?
Approximately 25% by 24 hours from onset of symptoms, 50% by 36 hours, and 75% by 48 hours
- What is the most com- Appendicitis (about 1/1750; appendix may be in mon general surgical ab- the RUQ because of the enlarged uterus) dominal emergency in pregnancy?
- What are the possible Pelvic abscess, liver abscess, free perforation, complications of appen- portal pylethrombophlebitis (very rare) dicitis?
- What percentage of the 15% population has a retro- cecal, retroperitoneal ap- pendix?
- What percentage of neg- Up to 20%; taking out some normal appendixes is ative appendectomies is better than missing a case of acute appendicitis acceptable? that eventually ruptures
- Who is at risk of dying Very old and very young patients from acute appendicitis?
- What bacteria are asso- Yersinia enterolytica ciated with "mesenteric adenitis" that can close- ly mimic acute appendici- tis?
- What is an "incidental ap- Removal of normal appendix during abdominal pendectomy"? operation for different procedure
- What are complications SBO, enterocutaneous fistula, wound infection, of an appendectomy? infertility with perforation in women, increased in- cidence of right inguinal hernia, stump abscess
- Wound infection
