ACUTE APPENDICITIS

Question 1

CLINICAL FEATURES -
HISTORY
• ___________________ PAIN
• ANOREXIA
• VOMITTING that comes (before or after ?) pain
•____________
•_________
• LMP

Answer 1

MIGRATORY RIGHT ILIAC FOSSA

After

FEVER; DIARRHOEA

Question 2

CLINICAL FEATURES -
EXAMINATION
• USUALLY ___________ LOOKING
• RIF _________
•___________ TENDERNESS
•____________ SIGN
•__________ SIGN
•_____________ SIGN

Answer 2

HEALTHY

TENDERNESS; REBOUND

ROVSING’S; PSOAS

OBTURATOR

Question 3

CLINICAL FEATURES -
INVESTIGATIONS
• Clinical diagnosis
•FULL BLOOD COUNT
•______________
•________________
•____________________

Answer 3

ABDOMINO-PELVIC ULTRASOUND

ABDOMINOPELVIC CT SCAN

LAPAROSCOPY

Question 4

Most common cause of acute surgical abdomen worldwide is??

Answer 4

Acute appendicitis

Question 5

Age of incidence
* Peak: ____-_____ years
* Can occur at any age (kids + elderly = atypical & dangerous)

Answer 5

10–30

Question 6

Appendicitis is (more or less?) common but (more or less?) lethal in the elderly due to _____________ .

Answer 6

Less; more

delayed diagnosis

Question 7

Etiopathogenesis

OBSTRUCTION → INFECTION → ISCHEMIA → PERFORATION.
A. Initiating Event: Luminal Obstruction
Most common causes:
1.________________ – most common in adults
2.__________________ – common in children (post-viral)
3. Parasites (e.g., ________________)
4. Foreign bodies
5. Tumors (carcinoid, adenocarcinoma – especially in elderly)

Answer 7

Fecalith (appendicolith)

Lymphoid hyperplasia

Enterobius vermicularis

Question 8

Pathophysiologic Cascade of acute appendicitis Once obstructed:
1. Continued ___________
2. ↑ _____________
3. Venous & lymphatic congestion
4. ↓____________
5. ___________
6. Bacterial overgrowth
7. Inflammation → __________
8.__________ → peritonitis or localized abscess

Answer 8

mucus secretion

Intraluminal pressure

Arterial inflow ; Ischemia

necrosis; Perforation

Question 9

Timeline:
* Perforation usually occurs ____________ after symptom onset

Answer 9

24–72 hours

Question 10

Clinical Features of AA

Classic progression =
A. Pain
Visceral → Somatic
1. Initial pain
* (dull or sharp?) , vague.
*Located at the _________ (_____ dermatome)
* Visceral pain
2. Later pain
* (dull or sharp?), localized
*located at _________
* _______________ irritation

Answer 10

Dull

Periumbilical

T10; sharp ; Right iliac fossa (RIF)

Parietal peritoneum

Question 11

McBurney’s point

Define

Answer 11

Is a point located at the Junction of lateral 1/3 and medial 2/3 of an imaginary line connecting the Right ASIS to umbilicus

Question 12

If Vomiting occurs before pain → think ____________ , not appendicitis.

Answer 12

gastroenteritis

Question 13

Physical Signs of AA
Local Signs
* Tenderness at _________
*______________ (Blumberg sign)
*__________ / rigidity
* Rovsing’s sign
* LIF palpation → RIF pain
* Psoas sign
*_________ appendix
* Obturator sign
* ________ appendix

Answer 13

McBurney’s point

Rebound tenderness

Guarding; Retrocecal

Pelvic

Question 14

Scoring Systems
Alvarado Score (MANTRELS)

???

Score ≥____ → likely appendicitis

Answer 14

Migration of pain
* Anorexia
* Nausea/vomiting
* Tenderness RIF
* Rebound pain
* Elevated temperature
* Leukocytosis
* Shift to left (neutrophils)

7

Question 15

Treatment of AA

A. Initial Management
*______
*________
* Analgesia (titrate to avoid __________)
* Broad-spectrum antibiotics

B. Definitive Treatment
1. ____________ (Gold Standard)

2. Antibiotic-Only Management
   * Selected uncomplicated cases
   * Higher recurrence rate (~20–30%)

Answer 15

NPO

IV fluids; masking pain

Appendectomy

Question 16

Complications
If untreated or delayed:
*_____________
*__________
* Appendicular __________
* Appendicular _________ (___________ )
* Sepsis
* ____________________(late)

Answer 16

Perforation; Peritonitis

abscess; mass ; phlegmon

Adhesive intestinal obstruction

Question 17

Appendicular Mass
* Conservative management (______________ regimen)
* ________________ after _________

Answer 17

Ochsner-Sherren

Interval appendectomy

6–8 weeks

Question 18

An appendiceal mass is a serious complication of acute appendicitis, where the body walls off a __________________ using the __________ and ___________ , forming a ____________ (inflammatory mass) or abscess

Answer 18

perforated appendix

omentum and adjacent bowel

phlegmon

Question 19

Rovsing’s Sign
*___________ of left iliac fossa
*___________ felt in right iliac fossa

Answer 19

Deep palpation

Pain

Question 20

Baldwin’s Sign
* Pain in RIF during _____________
* Seen in retrocecal appendicitis

Answer 20

flexion of right hip

Question 21

Psoas Sign
How to elicit:
1._______________ of right hip
OR
2. Active flexion against resistance

Answer 21

Passive extension

Question 22

Obturator Sign
How to elicit:
*______ ______ and _______
* _________________ hip
Positive when:
* Hypogastric /______ pain
Indicates:
*__________ appendix
* Irritation of obturator internus muscle

Answer 22

Flex ; hip ; knee

Internally rotate

pelvic; Pelvic

Question 23

Dunphy’s Sign
* Increased pain when ___________

Answer 23

coughing

Question 24

Markle Sign (Heel Drop / Jar Test)
How:
* Patient _____________→ __________[
OR
* Gentle tapping on heel
Positive when:
* Pain in RIF

Answer 24

stands on toes

drops on heels

Question 25

Rectal & Pelvic Signs Digital Rectal Examination * Tenderness in ____________________ * Suggests __________ appendicitis Vaginal Examination * ___________ tenderness * Excludes ectopic pregnancy / PID

Answer 25

right lateral rectal wall pelvic; Right fornix