SURGERY- APPENDICITIS EXAM
QUESTIONS WITH COMPLETE
ANSWERS
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.
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
retrocecal (posterior)
near psoas muscle and ureter
, pain below McBurney's point
tender rectal / pelvic exam
few RBC / WBC in urine
maybe obturator sign - Answer-Location of appendix
pelvis (low)
near rectum or bladder
Fever (not very high initially) / leukocytosis
Abdominal distention (later)
Possible superficial hyperesthesia -
Sensitivity when stroking skin in RLQ
Right testicular symptoms
(depending on location of appendix)
"Rebound tenderness","positive heel tap," and other signs of peritonitis are not specific
for appendicitis. - Answer-Appendicitis
More S&S
Distention of the lumen peri-umbilical pain
After perforation, there is no more distention of the lumen, so maybe no more peri-
umbilical pain.
But with pus spilling out into the RLQ, causing peritonitis, there must STILL be RLQ
pain!
*There is no reason for the RLQ pain to "go away" after perforation.* - Answer-Pain
"goes away" after perforation??
Mostly CBC, UA, pregnancy test
CBC - WBC usually mildly elevated
-Might even be normal
-*Unusual to be extremely high early on*
U / A - might have few RBC or WBC (depending on location of appendix)
-retrocecal appendicitis - near ureter
-pelvic appendicitis - near bladder
HCG for young females - to rule out ectopic pregnancy
Electrolytes? - probably normal, unless there is prolonged vomiting
Other blood chemistries? - probably normal, or with slight non-specific elevation -
Answer-Appendicitis
Diags and Tests
Flat + upright abdomen and CXR
Few specific findings for appendicitis
Maybe sentinel loop of bowel with air, calcified appendicolith, lumbar spine bending
toward the right (due to guarding)
No pathognomonic sign on plain film - Answer-Appendicitis
Imaging
QUESTIONS WITH COMPLETE
ANSWERS
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.
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
retrocecal (posterior)
near psoas muscle and ureter
, pain below McBurney's point
tender rectal / pelvic exam
few RBC / WBC in urine
maybe obturator sign - Answer-Location of appendix
pelvis (low)
near rectum or bladder
Fever (not very high initially) / leukocytosis
Abdominal distention (later)
Possible superficial hyperesthesia -
Sensitivity when stroking skin in RLQ
Right testicular symptoms
(depending on location of appendix)
"Rebound tenderness","positive heel tap," and other signs of peritonitis are not specific
for appendicitis. - Answer-Appendicitis
More S&S
Distention of the lumen peri-umbilical pain
After perforation, there is no more distention of the lumen, so maybe no more peri-
umbilical pain.
But with pus spilling out into the RLQ, causing peritonitis, there must STILL be RLQ
pain!
*There is no reason for the RLQ pain to "go away" after perforation.* - Answer-Pain
"goes away" after perforation??
Mostly CBC, UA, pregnancy test
CBC - WBC usually mildly elevated
-Might even be normal
-*Unusual to be extremely high early on*
U / A - might have few RBC or WBC (depending on location of appendix)
-retrocecal appendicitis - near ureter
-pelvic appendicitis - near bladder
HCG for young females - to rule out ectopic pregnancy
Electrolytes? - probably normal, unless there is prolonged vomiting
Other blood chemistries? - probably normal, or with slight non-specific elevation -
Answer-Appendicitis
Diags and Tests
Flat + upright abdomen and CXR
Few specific findings for appendicitis
Maybe sentinel loop of bowel with air, calcified appendicolith, lumbar spine bending
toward the right (due to guarding)
No pathognomonic sign on plain film - Answer-Appendicitis
Imaging
