Surgery > Appendix > Flashcards

Appendix Flashcards

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1
Q

MC and 2nd MC position of appendix

A

retrocaecal> pelvic

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2
Q

least common position of appendix

A

post ileal

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3
Q

location of base of appendix

A

constant - junction of 2 taenia coli

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4
Q

McBurney’s point

A

jnc of lateral 1/3rd and medial 2/3 rd and spinoumbilical line (R)

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5
Q

blood supply of appendix

A

appendicular - branch of lower division of ileocolic artery

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6
Q

artery of Seshachalam

A

branch of post caecal artery (accessory appendicular artery)

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7
Q

MC site of perforation of appendix and why

A

tip
absence of mesoappendix

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8
Q

MCC of # of lumen of appendix

A

fecolith

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9
Q

MC presenting symptom of acute appendicitis

A

pain
periumbilical —> shifted to —-> RIF

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10
Q

signs in acute appendicitis

A
  1. tenderness at Mcburney point
  2. pointing sign
  3. Rovsing sign
  4. Psoas sign
  5. obturator sign
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11
Q

non specific sign in acute appendicitis

A

Dunphry
Aaron
Ten horn

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12
Q

Rovsing sign

A

Pain in the right iliac fossa, when LIF is pressed

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13
Q

Psoas sign

A

pain in RIF on hyper extension of right hip

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14
Q

Obturator sign

A

pain in RIF on flexion and internal rotation of hip

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15
Q

Pointing sign

A

When asked to point to site of maximum pain, patient point towards McBurney’s point

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16
Q

Aaron sign

A

Pain in epigastrium when RIF is pressed

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17
Q

Dunphry sign

A

Pain on coughing

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18
Q

Ten horn sign

A

pain in RIF when right testes is pulled

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19
Q

Location specific sign: retro caecal appendix

A

psoas sign +
patient keeps right leg in flexion

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20
Q

Location specific sign: pelvic appendicitis

A

irritate bladder increased frequency
Irritates, rectum, pelvic diarrhoea, tenesmus
Pain on DRE

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21
Q

most difficult to diagnose appendicitis

A

Post ileal

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22
Q

IOC appendicitis children

A

usg

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23
Q

IOC appendicitis adults

A

CECT

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24
Q

IOC appendicitis in pregnant

A

USG/ MRI

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25
USG findings appendicitis
Blind ending tubular structures. • Probe tenderness. • fecolith may be seen • Periappendiceal fluid collection.
26
scoring system for acute appendicitis
Mantrels / modified Alvorado score
27
which criteria are given a score of two in mantrels scoring system?
tenderness in right lower quadrant And leucocytosis
28
criteria in Mantrels score
M - migration of pain to, right lower quadrant A anorexia N nausea, and vomiting T tenderness, in right, lower quadrant R rebound pain E elevated temperature L leukocytosis S shift of WBC count to left
29
ddx appendicitis infants and children
Yersinia intusussception MDitis ureteric colic bowel #
30
Ddx appendicitis adults
ureterix colic bowel Obstruction Torsion Gastroenteritis
31
DDX appendicitis adult female
endometriosis Mittelschmerz PID Ectopic pregnancy
32
incisions for appendicectomy
1.McBurney grid iron Rutherford Morrison 2.Lanz 3.lower midline abdominal
33
Lanz incision
2 cm below umbilicus centred over line joining mid clavicular and mid inguinal point
34
incision used when there is appendicular perforation
Lower midline incision
35
Structures cut through during open appendicectomy
skin Superficial fascia External oblique aponeurosis Muscles split or cut Pre-peritoneal fat Peritoneum
36
Ports used in laparoscopic appendicectomy
infraumbilical LIF Supra pubic region
37
length of stump of appendix
<4-5 mm or it can cause stump appendicitis
38
appendix cannot be located. Next step.?
Identify tinea coli and trace till base
39
Appendix is not inflamed next step?
search last 2 feet of ileum for inflamed MD
40
base of appendix is inflamed, next step?
1. Don’t crush the base. 2.bury the base by purse strings or z stitch 3. Linear stapler if caecal base is healthy.
41
base is gangrenous along with adjacent caecal wall next step
right hemicolectomy
42
appendectomy in Crohns
if caecum healthy - appendicetomy if inflamed - conservative
43
Cx appendicectomy
bleeding Wound infection (MC) Injury to nerve Portal Pyaemia Pelvic abscess Stump appendicitis
44
nerve injured in appendicectomy, and its consequence
iliohypogastric nerve inc risk of R inguinal hernia
45
appendicular perforation is common in
1. children 2. elderly 3. pregnant 4. adhesions 5. immunocompromised(DM) 6. presence of appendicolith
46
mx appendicular perforation
Lower midline incision appendicectomy
47
MC non obstetrical abdominal emergency
appendicitus
48
Mx of appendicitis in pregnancy
Laparoscopic appendectomy in all trimester
49
CF appendicitis pregnancy
pain in RIF (some patients - slightly higher up )
50
Mx appendicular lump
Oshner Sherren regime
51
If symptoms do not subside with Oshner Sherren regime , next step?
indicates appendicular abscess Extra peritoneal drainage is done
52
If symptoms subside with Oshner Sherren regime , next step?
discharge patient Interval appendicectomy after 6 weeks
53
MC tumor in appendix
Neuroendocrine tumor/ carcinoid tumour - now known as ANEN
54
MC site of carcinoid tumors
appendix (tip)
55
Mx ANEN > 2 cm or close to base :
right hemicolectomy
56
Mx ANEN <2 cm AND away from base :
<1 cm : simple appendicectomy with removal of mesoappendix 1-2 cm , close to base, poorly differentiated or T4 disease : right hemicolectomy
57
most important prognostic factor in ANEN
Size of the tumour
58
Grade of ANEN is determined by
Mitotic index Ki67
59
causes of Pseudomyxoma peritoni
1. appendiceal mucinous neoplasm 2. Ovarian mucinous neoplasm. 3. Primary peritoneal Cancer.
60
MC malignant tumour of appendix
mucinous adenocarcinoma
61
Dx of pseudomyxoma peritoni is made on
omental bx
62
Rx of pseudomyxoma peritoni
debulking/ cytoreductivr sx
63
Cytoreductive sx components
1. appendicectomy 2. R hemicolectomy if appendix is primary. 3. Total abdominal hysterectomy plus B/L SPO 4. Omentectomy 5. peritoneal nodules stripping f/b HIPEC
64
HIPEC
hyperthermic intraperitoneal chemotherapy Paclitaxel or Mitomycin C at 40 to 41°C
Surgery
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