GI Disorders - Appendicitis

Question 1

What is appendicitis?

Answer 1

inflammation of the appendix wall

Question 2

Location and function of the appendix:

Answer 2

Location: RLQ attach to the cecum of the large intestine

Function: stores good bacteria to regenerate normal flora and remnant of evolutionary past

Question 3

Acute or chronic? prevalence?

Answer 3

• acute onset
• usually age 5-30 y/o (peak at 20-30 y/o)
• common in younger individuals

Question 4

Etiology of Appendicitis

Answer 4

• largely idiopathic
• twisting of the bowel or appendix: associated area become knotted and obstructed resulting in inflm
• intraluminal obstruction: fecalith may be responsible

Question 5

What is a fecalith?

Answer 5

a small hard fecal particle

Question 6

Etiology: intraluminal obstruction

Answer 6

When there’s a change in dig tract, there is an increase in mucous secretion which increase luminal pressure. This pressure constricts outflow of vein and blood vessels causing venous stasis.

Question 7

Patho of Appendicitis

Answer 7

obstructed lumen –> drainage blocked (in cecum) –> increase luminal pressure (d/t increase mucous secretion)–>
exceeds venous pressure –> venous stasis–> ischemia –> infarction –> bacteria invades wall of appendix (bacteria moves to necrotic tissue in wall of appendix)

Question 8

Complications of appendicitis

Answer 8

• perforation
• rupture of appendix
• peritonitis

Question 9

manifestations

Answer 9

• acute pain onset in epigastric and periumbilical
• N/V
• pain increased and colicky (~12 hours)
• localized in RLQ (rebound)
• increase temp w/ leukocytes

Question 10

What is colicky?

Answer 10

• pain arises abruptly
• sharp pain
• starts and stops continuously
• persistant pain

Question 11

What type of pain is felt in appendicitis? How long does the pain localize to the appendix?

Answer 11

Migratory pain = pain felt somewhere disappears and felt elsewhere

It is associated with referred pain in which it is felt somewhere else than the site of injury.

In the next 12 hours.

Question 12

How is nausea and vomit rely to the brain? Which pathway?

Answer 12

• severe pain triggers the nausea and vomit reflex center,
• the appendix is a visceral organ and when it become inflamed and painful, messages from the appendix are sent to the CNS via visceral afferent pathways
• pain sensation is carried by the afferent nerves to the pain center which is in close proximity to the N/V reflex center

Question 13

Diagnosis

Answer 13

• hx and px (McBurney’s Point)

- US/CT to determine size

Question 14

What is McBurney’s Point? Where?

Answer 14

o When palpate at that site there is pain and rebounding pain (tenderness)

o Anatomic location: right side of the abdomen that is 1/3 of the distance from the ant. Sup. Iliac spine to the umbilicus

Question 15

Treatment (3) What sx?

Answer 15

• antibiotics
• IV fluids
• Appendectomy: performed in 24-48 hrs when there’s potential for rupture or perforation

Question 16

Complications

Answer 16

• perforation
• rupture of appendix
• peritonitis