Acute Appendicitis

Question 1

• most common emergency general surgical disease affecting the abdomen
• occurs most commonly in 10- to 19-year-old
• 70% of patients are <30 years old
• most are men
• perforation
  + most important causes of excess morbidity and mortality
  + 20%- higher in patients under 5 or over 65 years of age

Answer 1

Appendicitis

Question 2

CLINICAL MANIFESTATIONS OF APPENDICITIS

What is the classic history?

Answer 2

• changes in bowel habits or malaise and vague, perhaps intermittent, crampy, abdominal pain in the epigastric or pertumbilical region
• pain subsequently migrates to the right lower quadrant over 12-24 h
• abdominal pain -> nausea, vomiting
• Anorexia

Question 3

Palpating in left lower quadrant causes pain in the right lower quadrant

Answer 3

Rovsing’s sign

Question 4

Internal rotation of the hip causes pain, suggesting the

possibility of an inflamed appendix located in the pelvis

Answer 4

Obturator sign

Question 5

Extending the right hip causes pain along posterolateral back and hip, suggesting retrocecal appendicitis

Answer 5

lliopsoas sign

Question 6

• sensitivity is 0.86, with a specificity of 0.81

- include wall thickening, an increased appendiceal diameter, and the presence of free fluid

Answer 6

Ultrasonography

Question 7

• Sensitivity 0.94 and specificity 0.95,
• dilatation >6 mm with wall thickening, a lumen that does not fill with enteric contrast, and fatty tissue stranding or air surrounding the appendix

Answer 7

CT Scan

Question 8

• inflammation of the visceral and parietal peritoneum,
• is most often but not always infectious in origin (secondary peritonitis)
• perforation of a hollow viscus.

Answer 8

Peritonitis

Question 9

when a specific intraabdominal source cannot be identified

Answer 9

Primary or spontaneous peritonitis

Question 10

• most commonly caused by the abnormal presence of physiologic fluids (gastric juice, bile, pancreatic enzymes, blood, or urine)
• effects of normally sterile foreign bodies (surgical sponges or instruments)
• complication of systemic diseases like lupus erythematosus, porphyria, and familial Mediterranean fever.

Answer 10

Aseptic peritonitis

Question 11

• cardinal signs and symptoms
  + acute, typically severe, abdominal pain with tenderness and fever
• Diffuse, generalized peritonitis
  + diffuse abdominal tenderness with local guarding, rigidity
• Bowel sounds are usually absent to hypoactive
• Tachycardia and signs of volume depletion with hypotension
• Laboratory test- leukocytosis, acidosis
• Radiographic studies- dilatation of the bowel and associated bowel wall edema
• Stable patients with ascites- paracentesis

Answer 11

Peritonitis