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Questions and Answers
What initially triggers the visceral pain fibers from the appendix?
What initially triggers the visceral pain fibers from the appendix?
Which symptom is considered the primary symptom in acute appendicitis?
Which symptom is considered the primary symptom in acute appendicitis?
At what spinal cord level do the visceral afferent pain fibers from the appendix enter?
At what spinal cord level do the visceral afferent pain fibers from the appendix enter?
In the classic presentation of appendicitis, the initial pain is perceived in which area?
In the classic presentation of appendicitis, the initial pain is perceived in which area?
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What may occur in male patients experiencing retroileal appendicitis?
What may occur in male patients experiencing retroileal appendicitis?
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Which of the following may result from the increased intraluminal pressure in acute appendicitis?
Which of the following may result from the increased intraluminal pressure in acute appendicitis?
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What is a possible complication following perforation of the appendix?
What is a possible complication following perforation of the appendix?
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How is abdominal pain typically described in the early stages of appendicitis?
How is abdominal pain typically described in the early stages of appendicitis?
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What causes the localization of pain in acute appendicitis in the right lower quadrant?
What causes the localization of pain in acute appendicitis in the right lower quadrant?
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What is the primary cause that initiates acute appendicitis?
What is the primary cause that initiates acute appendicitis?
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In cases of retrocecal appendicitis, where may the pain localize instead of the typical right lower quadrant?
In cases of retrocecal appendicitis, where may the pain localize instead of the typical right lower quadrant?
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What percentage of human appendix specimens removed over a 40-year period were found to be retrocecal?
What percentage of human appendix specimens removed over a 40-year period were found to be retrocecal?
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Why is the incidence of appendectomy appearing to decline?
Why is the incidence of appendectomy appearing to decline?
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What can lead to an increase in intraluminal pressure in the appendix?
What can lead to an increase in intraluminal pressure in the appendix?
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How might appendicitis presentations vary?
How might appendicitis presentations vary?
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What is one common cause of obstruction in the lumen leading to acute appendicitis?
What is one common cause of obstruction in the lumen leading to acute appendicitis?
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What is the sensitivity and specificity of localized pain in the right lower quadrant for diagnosing acute appendicitis?
What is the sensitivity and specificity of localized pain in the right lower quadrant for diagnosing acute appendicitis?
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Which symptom is the most common in patients with acute appendicitis?
Which symptom is the most common in patients with acute appendicitis?
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When do the classic symptoms of appendicitis typically appear in relation to abdominal pain?
When do the classic symptoms of appendicitis typically appear in relation to abdominal pain?
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What maneuver is associated with eliciting a positive psoas sign in suspected acute appendicitis?
What maneuver is associated with eliciting a positive psoas sign in suspected acute appendicitis?
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What is the sensitivity and specificity of the migration of pain from the periumbilical area to the right lower quadrant for diagnosing acute appendicitis?
What is the sensitivity and specificity of the migration of pain from the periumbilical area to the right lower quadrant for diagnosing acute appendicitis?
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Which sign is evaluated by flexing the right hip and knee and then internally rotating the hip?
Which sign is evaluated by flexing the right hip and knee and then internally rotating the hip?
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Which physical examination component is NOT typically associated with diagnosing acute appendicitis?
Which physical examination component is NOT typically associated with diagnosing acute appendicitis?
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Which of the following statements about vomiting in acute appendicitis is true?
Which of the following statements about vomiting in acute appendicitis is true?
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What may indicate a positive obturator sign in a patient with acute appendicitis?
What may indicate a positive obturator sign in a patient with acute appendicitis?
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What is a common finding in the early stages of acute appendicitis concerning the patient's temperature?
What is a common finding in the early stages of acute appendicitis concerning the patient's temperature?
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Which physical examination finding is likely to develop as acute appendicitis progresses?
Which physical examination finding is likely to develop as acute appendicitis progresses?
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Which of the following statements regarding the diagnosis of acute appendicitis is true?
Which of the following statements regarding the diagnosis of acute appendicitis is true?
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In a pelvic appendix, where is tenderness most likely to be pronounced during examination?
In a pelvic appendix, where is tenderness most likely to be pronounced during examination?
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What might be a contributing factor when testing for acute appendicitis in women of childbearing age?
What might be a contributing factor when testing for acute appendicitis in women of childbearing age?
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What is the typical temperature rise observed in a patient with acute appendicitis during its progression?
What is the typical temperature rise observed in a patient with acute appendicitis during its progression?
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What might the Rovsing sign indicate in a patient being examined for appendicitis?
What might the Rovsing sign indicate in a patient being examined for appendicitis?
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Which diagnostic method is commonly used to differentiate obstetric causes of pain from appendicitis?
Which diagnostic method is commonly used to differentiate obstetric causes of pain from appendicitis?
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What is a potential consequence of delayed diagnosis of appendicitis in very young patients?
What is a potential consequence of delayed diagnosis of appendicitis in very young patients?
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In which population is appendicitis more likely to present with atypical symptoms and delayed diagnosis?
In which population is appendicitis more likely to present with atypical symptoms and delayed diagnosis?
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What commonly complicates the diagnosis of appendicitis in children under 5 years of age?
What commonly complicates the diagnosis of appendicitis in children under 5 years of age?
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What sign may indicate peritonitis in children?
What sign may indicate peritonitis in children?
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Why might children exhibit atypical symptoms related to appendicitis?
Why might children exhibit atypical symptoms related to appendicitis?
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What is a common complication linked with appendicitis in patients with AIDS?
What is a common complication linked with appendicitis in patients with AIDS?
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What can complicate the presentation of appendicitis in young children?
What can complicate the presentation of appendicitis in young children?
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Which factor contributes to the higher incidence of perforation in elderly patients with acute appendicitis?
Which factor contributes to the higher incidence of perforation in elderly patients with acute appendicitis?
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What are the recommended preoperative steps for patients preparing for an appendectomy?
What are the recommended preoperative steps for patients preparing for an appendectomy?
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What is the standard treatment for acute appendicitis?
What is the standard treatment for acute appendicitis?
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In which situation can fetal mortality rates be significantly affected due to appendicitis?
In which situation can fetal mortality rates be significantly affected due to appendicitis?
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What role do antibiotics play in the management of patients with uncomplicated appendicitis?
What role do antibiotics play in the management of patients with uncomplicated appendicitis?
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What is a significant predictor of acute appendicitis in elderly patients?
What is a significant predictor of acute appendicitis in elderly patients?
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What is the role of imaging techniques like ultrasound and CT scan in the diagnosis of appendicitis?
What is the role of imaging techniques like ultrasound and CT scan in the diagnosis of appendicitis?
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What complication can occur due to late diagnosis of appendicitis in elderly patients?
What complication can occur due to late diagnosis of appendicitis in elderly patients?
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Study Notes
Acute Appendicitis
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Epidemiology: Incidence of appendectomy appears to be declining due to more accurate preoperative diagnoses, despite newer imaging techniques still making diagnosis difficult.
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Pathophysiology: Acute appendicitis likely begins with lumen obstruction (food, adhesions, lymphoid hyperplasia). Mucosal secretions increase intraluminal pressure, exceeding capillary pressure, obstructing venous/lymphatic drainage, leading to mucosal breakdown, bacterial invasion, inflammatory response, edema, increased pressure, arterial stasis, and tissue infarction causing perforation and spillage into the peritoneum.
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Pain Migration: Initial pain is periumbilical/epigastric, migrating to the right lower quadrant as inflammation extends, due to somatic pain fiber innervation of the peritoneum. Variations exist: retrocecal appendix pain may localize to flank, right upper quadrant pain in pregnancy due to uterine displacement, retroileal appendicitis may irritate the ureter causing testicular pain, and pelvic appendicitis may irritate the bladder or rectum.
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Clinical Features: The primary symptom is abdominal pain, sometimes evolving from epigastric/periumbilical pain to right lower quadrant localization. Other common features: anorexia, nausea, vomiting, in approximately half of the patients. Tenderness especially over McBurney's point (midway between umbilicus and anterior superior iliac spine) may be detected later in the illness, with possible Rovsing sign (palpating left lower quadrant causing pain in right).
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Physical Examination: Diagnostic signs include rebound tenderness, involuntary guarding, local muscular rigidity, tenderness on rectal examination, psoas sign, and obturator sign based on palpated pain response. Fever is typically a later finding.
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Diagnosis: Suspect in individuals with epigastric, periumbilical, right flank or right-sided abdominal pain who haven't had an appendectomy. Pelvic/pregnancy examination necessary for women of childbearing age. Additional studies like CBC, urinalysis, imaging aid diagnosis. Clinical observation is also crucial.
Special Populations
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Young Patients: Misdiagnosis rates are high, with consequent increase in perforation rate, especially in children under 5.
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Elderly Patients: Misdiagnosis rates exceed 50%, perforation rates are high (40-70%), and mortality rates in patients over 70 are high (30%).
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Pregnant Patients: Appendicitis is a common extra-uterine emergency in pregnancy, with increased risk of fetal mortality due to delays in diagnosis.
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AIDS Patients: Symptoms are similar but diagnosis can be delayed due to baseline gastrointestinal symptoms and possible concurrent non-surgical conditions. White blood cell count (WBC) is not typically elevated even with acute appendicitis.
Treatment
- Appendectomy: The standard of care for acute appendicitis, involve preoperative antibiotics, intravenous fluid resuscitation, and nothing by mouth. Early antibiotics are effective in uncomplicated cases, and are crucial in cases of perforation to prevent postoperative abscess formation.
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Description
This quiz explores the epidemiology and pathophysiology of acute appendicitis, including the mechanisms behind its development and pain migration. Understand the factors affecting diagnosis and clinical presentation variations, enhancing your knowledge about this common surgical condition.
