Appendicitis - lower GI

Question 1

What is the name for a very hard piece of faeces?

Answer 1

Faecolith

Question 2

What is the pathophysiology of appendicitis?

Answer 2

• Obstruction of lumen by a faecolith (very hard piece of faeces)
• –> Appendix constricts to try + drive faecolith out of appendix
• –> increased pressure in bowel wall
• –> inference with blood supply (ischaemic changes)
• –> decreases walls resistance to bacterial infection
• –> Inflammation of wall (via bacterial invasion)

Question 3

Which 2 organisms are commonly associated with appendicitis?

Answer 3

1. E. Coli
2. Streptococci

Question 4

Describe the processes that occur during appendicitis.

Answer 4

• earliest lesion: ulceration of mucosa surface
• Interference with circulation
• –> to areas of necrosis and perforation with spread to the peritoneal cavity
• walled off infection –> localised abscess (localised area of tissue necrosis) which can eventually
• –> to generalised peritonitis

Question 5

Are symptoms associated with obstruction poorly localised or well localised?

Answer 5

poorly localised

Question 6

Is pain associated with peritonitis similar to obstruction?

Answer 6

NO - obstruction = poorly localised

Question 7

Describe the progression of pain in appendicits.

Answer 7

abdominal pain

• initially was generalized,
• but then localized to the right lower quadrant.

Question 8

What are some visual signs of appendicitis seen during autopsy?

Answer 8

• yellow/tan exudate
• hyperaemia

note: hyperaemia = excess of blood in vessels supplying a structure

Question 9

What are some microscopic signs of acute appendicitis?

Answer 9

• mucosal inflammation
• mucosal ulceration
• necrosis
• neutrophilic exudate.

Question 10

What can be seen on blood results that indicates appendicitis?

Answer 10

raised WBC

Question 11

What is the clinical presentation of appendicitis?

Answer 11

• Begins with generalised central abdominal pain (referred pain)
• Pain shifts to right iliac fossa over a few hours to a few days, and is more severe
• loss of appetite
• nausea
• vomiting

Question 12

What is the clinical presentation of generalised peritonitis?

Answer 12

• generalised abdominal pain
• nausea and vomiting
• sweating,
• rigors