Acute Appendicitis Overview
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Questions and Answers

What initially triggers the visceral pain fibers from the appendix?

  • Luminal distension (correct)
  • Bacterial infection
  • Tissue infarction
  • Appendiceal perforation

Which symptom is considered the primary symptom in acute appendicitis?

  • Abdominal pain (correct)
  • Fever
  • Suprapubic pain
  • Nausea and vomiting

At what spinal cord level do the visceral afferent pain fibers from the appendix enter?

  • T5
  • L1
  • C3
  • T10 (correct)

In the classic presentation of appendicitis, the initial pain is perceived in which area?

<p>Epigastrium or periumbilical region (D)</p> Signup and view all the answers

What may occur in male patients experiencing retroileal appendicitis?

<p>Pain in the testicle (C)</p> Signup and view all the answers

Which of the following may result from the increased intraluminal pressure in acute appendicitis?

<p>Vascular compromise (B)</p> Signup and view all the answers

What is a possible complication following perforation of the appendix?

<p>Spillage of infected contents (C)</p> Signup and view all the answers

How is abdominal pain typically described in the early stages of appendicitis?

<p>Vague and difficult to localize (B)</p> Signup and view all the answers

What causes the localization of pain in acute appendicitis in the right lower quadrant?

<p>Inflammation of somatic pain fibers innervating peritoneal structures (A)</p> Signup and view all the answers

What is the primary cause that initiates acute appendicitis?

<p>Obstruction of the appendiceal lumen (B)</p> Signup and view all the answers

In cases of retrocecal appendicitis, where may the pain localize instead of the typical right lower quadrant?

<p>Flank area (A)</p> Signup and view all the answers

What percentage of human appendix specimens removed over a 40-year period were found to be retrocecal?

<p>26 percent (A)</p> Signup and view all the answers

Why is the incidence of appendectomy appearing to decline?

<p>More accurate preoperative diagnosis (C)</p> Signup and view all the answers

What can lead to an increase in intraluminal pressure in the appendix?

<p>Obstruction leading to continued secretion (A)</p> Signup and view all the answers

How might appendicitis presentations vary?

<p>From anatomical variations of the appendix (C)</p> Signup and view all the answers

What is one common cause of obstruction in the lumen leading to acute appendicitis?

<p>Food matter accumulation (A)</p> Signup and view all the answers

What is the sensitivity and specificity of localized pain in the right lower quadrant for diagnosing acute appendicitis?

<p>81% sensitive and 53% specific (B)</p> Signup and view all the answers

Which symptom is the most common in patients with acute appendicitis?

<p>Anorexia (A)</p> Signup and view all the answers

When do the classic symptoms of appendicitis typically appear in relation to abdominal pain?

<p>After the onset of vague abdominal pain (C)</p> Signup and view all the answers

What maneuver is associated with eliciting a positive psoas sign in suspected acute appendicitis?

<p>Extension of the right leg at the hip (B)</p> Signup and view all the answers

What is the sensitivity and specificity of the migration of pain from the periumbilical area to the right lower quadrant for diagnosing acute appendicitis?

<p>64% sensitive and 82% specific (A)</p> Signup and view all the answers

Which sign is evaluated by flexing the right hip and knee and then internally rotating the hip?

<p>Obturator sign (C)</p> Signup and view all the answers

Which physical examination component is NOT typically associated with diagnosing acute appendicitis?

<p>Bruising around the umbilicus (C)</p> Signup and view all the answers

Which of the following statements about vomiting in acute appendicitis is true?

<p>About 50% of patients experience vomiting (C)</p> Signup and view all the answers

What may indicate a positive obturator sign in a patient with acute appendicitis?

<p>Increased pain when stretching the obturator muscle (B)</p> Signup and view all the answers

What is a common finding in the early stages of acute appendicitis concerning the patient's temperature?

<p>It may remain normal (D)</p> Signup and view all the answers

Which physical examination finding is likely to develop as acute appendicitis progresses?

<p>Localized tenderness in the right lower quadrant (A)</p> Signup and view all the answers

Which of the following statements regarding the diagnosis of acute appendicitis is true?

<p>It cannot occur in individuals who have had an appendectomy (B), Any individual with right-sided abdominal pain should be suspected (D)</p> Signup and view all the answers

In a pelvic appendix, where is tenderness most likely to be pronounced during examination?

<p>On rectal examination (C)</p> Signup and view all the answers

What might be a contributing factor when testing for acute appendicitis in women of childbearing age?

<p>Possible need for pelvic examination and pregnancy test (C)</p> Signup and view all the answers

What is the typical temperature rise observed in a patient with acute appendicitis during its progression?

<p>1 to 2 degrees Celsius (A)</p> Signup and view all the answers

What might the Rovsing sign indicate in a patient being examined for appendicitis?

<p>Pain in the right lower quadrant upon palpation of the left lower quadrant (C)</p> Signup and view all the answers

Which diagnostic method is commonly used to differentiate obstetric causes of pain from appendicitis?

<p>Clinical observation (B)</p> Signup and view all the answers

What is a potential consequence of delayed diagnosis of appendicitis in very young patients?

<p>Higher rates of perforation (B)</p> Signup and view all the answers

In which population is appendicitis more likely to present with atypical symptoms and delayed diagnosis?

<p>Patients with AIDS (A)</p> Signup and view all the answers

What commonly complicates the diagnosis of appendicitis in children under 5 years of age?

<p>Communication difficulties (D)</p> Signup and view all the answers

What sign may indicate peritonitis in children?

<p>Lethargy (C)</p> Signup and view all the answers

Why might children exhibit atypical symptoms related to appendicitis?

<p>Due to developmental age (C)</p> Signup and view all the answers

What is a common complication linked with appendicitis in patients with AIDS?

<p>Higher incidences of appendiceal perforation (C)</p> Signup and view all the answers

What can complicate the presentation of appendicitis in young children?

<p>Atypical respiratory conditions (A)</p> Signup and view all the answers

Which factor contributes to the higher incidence of perforation in elderly patients with acute appendicitis?

<p>Anatomic changes in the appendix (D)</p> Signup and view all the answers

What are the recommended preoperative steps for patients preparing for an appendectomy?

<p>Nothing by mouth and IV fluid resuscitation (B)</p> Signup and view all the answers

What is the standard treatment for acute appendicitis?

<p>Appendectomy (C)</p> Signup and view all the answers

In which situation can fetal mortality rates be significantly affected due to appendicitis?

<p>When complications arise from appendicitis (D)</p> Signup and view all the answers

What role do antibiotics play in the management of patients with uncomplicated appendicitis?

<p>They decrease the incidence of postoperative wound infections. (D)</p> Signup and view all the answers

What is a significant predictor of acute appendicitis in elderly patients?

<p>Tenderness and rigidity upon examination (C)</p> Signup and view all the answers

What is the role of imaging techniques like ultrasound and CT scan in the diagnosis of appendicitis?

<p>They help confirm the diagnosis. (C)</p> Signup and view all the answers

What complication can occur due to late diagnosis of appendicitis in elderly patients?

<p>Higher incidence of perforation (C)</p> Signup and view all the answers

Flashcards

Acute Appendicitis

Inflammation of the appendix, often starting with a blockage.

Obstruction Cause

Food, adhesions (scar tissue), or an overgrowth of immune cells (lymph) often block the appendix.

Inflammation Process

As inflammation grows, the appendix's outer lining and nearby tissues become inflamed.

Pain Location

Pain from acute appendicitis often starts near the belly button and moves to the lower right side.

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Anatomic Variation

The appendix's location can be unusual, impacting where pain is felt.

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Retrocecal Appendix

Appendix positioned behind the cecum (first part of the large intestine).

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Diagnosis Difficulty

Acute appendicitis can be hard to diagnose, even with modern tests.

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Incidence Decline

The number of appendectomies may be falling, likely due to better diagnosis before surgery.

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Appendicitis location

Appendicitis pain originates in the epigastrium or periumbilical region.

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Visceral pain

Initial pain from appendicitis is often vague and poorly localized.

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Appendicitis pain pattern

Pain in appendicitis typically begins vaguely in the belly button area and moves.

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Involved nerves

Visceral nerves from the appendix enter the spinal cord at the tenth thoracic vertebra.

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Appendix displacement

Appendix position can vary, leading to different pain locations, like flank, testicle, or suprapubic areas.

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Bacterial invasion

Breakdown of mucosa allows bacteria to enter the appendix.

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Tissue damage

Inflammation and swelling worsen the pressure inside the appendix, leading to impaired blood flow.

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Perforation causes

High intraluminal pressure from inflammation and swelling eventually leads to appendix rupture.

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Acute Appendicitis Symptoms

Early symptoms include vague abdominal pain, followed by anorexia, nausea, and vomiting. Pain often localizes to the right lower quadrant.

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Right Lower Quadrant pain

Pain in the lower right part of the abdomen, a common symptom of acute appendicitis.

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Psoas Sign

A diagnostic test for appendicitis; extending the leg causes pain if inflamed appendix irritates the psoas muscle.

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Obturator Sign

A diagnostic test to check for appendicitis. Pain when flexing and rotating the right hip tests for inflammation affecting the obturator muscle.

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Rebound Tenderness

A symptom of acute appendicitis, pain felt when pressure is released after applying pressure to the abdomen.

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Voluntary Guarding

A symptom of acute appendicitis; patient tenses abdominal muscles to reduce pain when pressure is applied.

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Involuntary Guarding

Patient unconsciously tightens abdominal muscles due to pain associated with acute appendicitis.

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Periumbilical Pain

Vague abdominal pain initially present in acute appendicitis, centered around the navel.

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Rovsing Sign

Pain in the right lower quadrant when the left lower quadrant is palpated. It suggests irritation of the appendix.

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McBurney's Point

A point located just below the middle of a line connecting the umbilicus and the anterosuperior iliac spine. It's a common site of tenderness in acute appendicitis.

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Temperature in Appendicitis

Temperature may be normal early on, but typically rises 1-2 degrees Celsius as the illness progresses. High temperatures (above 39°C) are uncommon in the early stages but may occur after appendix rupture.

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Acute Appendicitis Diagnosis

Suspect appendicitis in anyone with upper abdominal pain, especially if it migrates to the lower right abdomen and they haven't had an appendectomy.

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Pelvic Appendicitis

If the appendix is located in the pelvis, rectal examination may be the most sensitive way to detect tenderness.

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Importance of Gynecological Examination

Women of childbearing age should have a pelvic examination and pregnancy test to rule out other causes of abdominal pain.

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Timeframe for Physical Examination Findings

Physical examination findings in appendicitis depend on the stage of the illness. Early on, there may be minimal localized tenderness, but as it progresses, tenderness and signs like Rovsing's and obturator signs become more prominent.

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High index of suspicion

Being very alert and considering appendicitis as a serious possibility, especially in certain patient groups like children and the elderly.

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Appendicitis in elderly

Appendicitis is more dangerous in older people due to delayed diagnosis and higher perforation rates.

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Misdiagnosis rate in elderly

Appendicitis is often misdiagnosed in older adults, with rates exceeding 50%, because of its atypical presentation.

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Treatment for appendicitis

The standard treatment for acute appendicitis is surgery (appendectomy).

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Pre-operative care

Before surgery, patients with appendicitis are given IV fluids, antibiotics, and nothing by mouth (NPO).

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Benefits of antibiotics

Antibiotics given before surgery can help prevent infections and complications like wound infections and abscess formation.

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Appendicitis in pregnancy

Appendicitis in pregnant women is a serious concern with increased risk of complications for both mom and baby.

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Ultrasound in appendicitis

Ultrasound can help diagnose appendicitis, especially in pregnant women.

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Atypical Appendicitis

Appendicitis symptoms in certain groups (young kids, elderly, pregnant women, AIDS patients) can be different, leading to delayed diagnosis and more complications.

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Appendicitis in Children

Young children often experience atypical appendicitis symptoms, like respiratory issues or suspected gastroenteritis, making diagnosis tricky.

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Appendicitis in AIDS Patients

AIDS patients are more prone to complications from appendicitis, even with similar symptoms. Diagnosis can be delayed due to frequent unrelated GI symptoms.

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Peritonitis in Children

Inflammation of the abdominal lining in children can present uniquely, with signs like lethargy, inactivity, and low body temperature.

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Appendicitis Perforation

A ruptured appendix is a serious complication that can happen in anyone, but is more common in people with delayed appendicitis diagnosis.

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WBC in Appendicitis

White blood cell count (WBC) can be used to help diagnose appendicitis, but it's important to remember it can vary in individuals with AIDS.

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Diagnosis Challenges

Diagnosing appendicitis can be difficult due to varying symptoms, especially in certain patient groups like children and those with AIDS.

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Study Notes

Acute Appendicitis

  • Epidemiology: Incidence of appendectomy appears to be declining due to more accurate preoperative diagnoses, despite newer imaging techniques still making diagnosis difficult.

  • 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.

  • 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.

  • 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).

  • 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.

  • 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

  • Young Patients: Misdiagnosis rates are high, with consequent increase in perforation rate, especially in children under 5.

  • Elderly Patients: Misdiagnosis rates exceed 50%, perforation rates are high (40-70%), and mortality rates in patients over 70 are high (30%).

  • Pregnant Patients: Appendicitis is a common extra-uterine emergency in pregnancy, with increased risk of fetal mortality due to delays in diagnosis.

  • 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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Acute Appendicitis PDF

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.

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