Appendicitis and Diverticular Disease Flashcards Preview

Stage 2: Inflammation > Appendicitis and Diverticular Disease > Flashcards

Flashcards in Appendicitis and Diverticular Disease Deck (34)
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1
Q

What is the typical appendicitis patient?

A

Male, 10-20 year old

2
Q

How might someone with appendicitis present (classic presentation - 50%)?

A
  • Central abdominal pain that migrates to RIF
  • Pain worse on moving, coughing, driving over bumpy roads (peritonism)
  • Associated with nausea, vomiting, diarrhoea, anorexia
  • Low grade fever
3
Q

Why is appendicitis very severe in young children?

A

The omentum is not as fully developed and therefore cannot encapsulate infected tissue effectively so there is a higher risk of mortality

4
Q

What are 5 examination findings in appendicitis?

A

1) Guarding
2) Rebound tenderness
3) Percussion tenderness
4) Rovsing sign positive
5) Psoas sign positive

5
Q

Using what is a diagnosis of appendicitis made?

A

History, examination, supported by bloods and imaging

6
Q

What blood test results tend to indicate appendicitis?

A

Elevated WCC and/or CRP

7
Q

How many patients with acute appendicitis have perforation?

A

13-20%

8
Q

What are causes of appendicitis?

A

1) Faecoliths
2) Foreign bodies
3) Malignancy
4) Lymphoid hyperplasia during infection
5) Genetic

9
Q

What happens in appendicitis?

A

1) Luminal obstruction blocks escape of mucosal secretions
2) Increase in pressure causes engorgement and stasis
3) Necrosis and peforation

10
Q

When would you do investigations in suspected appendicitis?

A

To exclude other pathology (and support diagnosis)

11
Q

What tests would you always do in pre-menopausal women and why?

A

Pregnancy test and urine dip to exclude kidney-ureter-bladder infection and ectopic pregnancy

12
Q

With what normal blood test results is appendicitis much less likely?

A
  • CRP
  • ECC
  • Granulocyte count
  • Proportion of polymorphonuclear cells
13
Q

What imaging technique is best used in appendicitis?

A

CT with contrast

14
Q

If CT is contraindicated e.g. pregnancy/young people what are alternative imaging techniques to use in acute appendicitis?

A

Ultrasound/MRI

15
Q

What would you see in an uncomplicated acute appendicitis on a CTAP?

A
  • Retrocaecal medial origin inflamed appendix
  • Oedematous proximal component with tip extending superiorly and laterally, along right psoas
  • No associated collection or pneumoperitoneum
16
Q

What would you see in a colonoscopy in appendicitis?

A

The appendices orifice in the caecum will be yellow and covered in pus

17
Q

What surgery is done to treat appendicitis?

A

Laparoscopic appendicectomy

18
Q

What is diverticular disease?

A

The formation of sac-like protrusions of mucosa through the muscular colonic wall (leads to infection, bleeding, diverticular stricture) - common

19
Q

What is diverticular disease associated with and why?

A

Low fibre diet

  • Lowers stool bulk
  • Increases transit time and intra luminal pressure
20
Q

What happens to colonic muscle in diverticular disease?

A

It is hypertrophied

21
Q

What is diverticulosis?

A

Presence of diverticula without symptoms

22
Q

What happens to the patient in diverticular disease?

A

The diverticula cause intermittent lower abdominal pain, without inflammation or infection

23
Q

What is diverticulitis?

A

When the diverticula become infected and/or inflamed, causing marked lower abdominal pain, fever and general malaise

24
Q

What is complicated diverticulitis?

A

Diverticulitis accompanied by the formation of an abscess, perforation or fistula

25
Q

What is the presentation of someone with diverticular disease?

A
  • Intermittent lower abdominal pain
  • Change in bowel habit
  • 15% of people have abrupt, painless PR bleeding
26
Q

What are possible complications of diverticulitis?

A
  • Development of an abscess or fistula
  • Perforation/peritonitis
  • Intestinal obstruction
  • Dysuria/frequency
27
Q

What are the signs and symptoms of a colovesicle fistula?

A
  • Pneumaturia (bubbles on micturition)
  • Faecaluria (faecal matters in urine)
  • Dysuria
  • Haematuria
28
Q

What is the Hinchey classification used for?

A

Classification of stages of diverticular disease

29
Q

How do you treat stage I diverticular disease?

A

Antibiotics alone (7 day course)

30
Q

How do you treat stage II diverticular disease?

A

Percutaneous drainage with antibiotic cover

31
Q

How do you treat stage III diverticular disease?

A

Drainage, laparoscopic lavage with antibiotic cover

32
Q

How do you treat stage IV diverticular disease?

A

Hartmann’s procedure

33
Q

What is Hartmann’s procedure used to treat?

A
  • Peritonitis
  • IBD
  • Diverticular inflammatory mass/abscess/fistula, diverticular perforation/ haemorrhage
  • Sigmoid carcinoma - obstruction, perforation
  • Sigmoid volvulus
  • Colitis
  • Massive colonic haemorrhage
34
Q

Describe Hartmann’s procedure

A
  • Resect pathology in sigmoid colon

- End colostomy and closure of rectal stump