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Surgery – Appendicitis Exam Questions with Complete Answers
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Surgery – Appendicitis Exam Questions with Complete Answers
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Surgery – Appendicitis Exam Questionswith Complete Answers
obstruction of lumen, distention, infection
Fecal material (or inflammation of lymphatic tissue in appendix) -> obstruction of lumen
-> distention of lumen -> ischemia of appendiceal wall -> bacterial invasion (infection) -
Answer-Appendicitis
Pathogenesis
sometimes upper respiratory infection - Answer-Appendicitis
History prior to onset of disease -
most common in 10 - 40 year olds
but can occur at any age - Answer-Appendicitis
Incidence
obstruction in lumen of appendix
causes swelling and eventually decreased blood supply to the wall of the appendix. -
Answer-Appendicitis
Cause
DISTENTION of appendix
due to trapped secretions
causes peri-umbilical pain (distention of hollow organ)
INFLAMMATION -> SUPPURATION
due to invasion of bacteria into wall
causes RLQ pain (localized peritonitis)
PERFORATION (same as "rupture")
due to increasing distention
decreased blood supply to wall of appendix results in gangrenous wall that more easily
perforates - Answer-Appendicitis
Pathophysiology
There is swelling and injection of *distal half.*
There is purulent exudate, not only on appendix itself, but on other structures that it
touches.
This takes HOURS to develop.
There can not be sudden onset of symptoms. - Answer-Typical appearance of
suppurative appendicitis:
periumbilical pain
nausea, later vomiting
not tender yet
, pain / tenderness RLQ
low grade fever
mildly increased WBC
more pain / tenderness
more fever, higher WBC - Answer-Appendicitis
S&S
Appendicitis
Pathology (take 2) - Answer-obstruction of lumen
distention of appendix
appendix wall starts to lose blood supply
bacteria invade wall -> infection (suppurative appendicitis)
appendix wall perforates
feces and bacteria spill out (perforated appendicitis)
Appendicitis
S&S (take 2) - Answer-PERIUMBILICAL PAIN first (distention),
then RLQ pain (inflammation)
Almost always ANOREXIA, usually VOMITING
Later develops TENDERNESS
McBurney's point (if appendix is in iliac fossa)
rectal (if appendix is in the pelvis)
flank (if appendix is retrocecal)
These take MANY HOURS to DAYS to develop.
Appendicitis is generally NOT characterized by sudden onset of RLQ pain.
Locations of the appendix - Answer-
behind the cecum -> can cause flank pain, CVA tenderness, -> positive psoas sign,
*few WBCs / RBCs in urine (near ureter)* - Answer-Retrocecal =
RLQ pain and tenderness
no psoas sign - Answer-Location of appendix
iliac fossa (anterior)
near anterior abdominal wall
flank pain and tenderness
no pain on rectal exam
few RBC / WBC in urine (near ureter)
maybe psoas sign - Answer-Location of appendix
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