Acute Abdomen and Appendicitis

Flashcards covering key definitions, pathophysiology, clinical features, diagnostic scoring, incisions, and management options for acute abdomen and appendicitis based on lecture notes.

How is the acute abdomen defined according to Mont Ride?

Undiagnosed pain that develops suddenly and is less than $7$ days in duration.

Why is the use of painkillers discouraged in patients with an acute abdomen prior to clinical examination?

Painkillers may mask symptoms and alter the findings of the clinical examination.

Which embryological origin corresponds to visceral pain experienced in the epigastrium?

Foregut structures (stomach to second portion of duodenum, pancreas, gallbladder, and liver).

Where is visceral pain originating from midgut structures typically felt?

In the periumbilical region.

What is the classic site of referred pain for biliary colic?

The right shoulder or scapula.

Where does pain refer in a patient with a perforated peptic ulcer?

To the right lower quadrant (RLQ) via the right paracolic gutter.

What non-surgical or neuro-metabolic cause of acute abdomen is associated with heavy metal toxicity?

Lead poisoning.

What general appearance or posture in bed is typical of a patient with active peritonitis?

Immobility with knees drawn up to relax the abdominal wall.

What clinical condition is indicated by Kussmaul respirations in a patient presenting with abdominal pain?

Diabetic ketoacidosis.

At what anatomical mark is the base of the vermiform appendix constantly located?

At the confluence of the three taeniae coli of the caecum.

What is the most common anatomical position of the vermiform appendix?

The retrocaecal position ($74\%$).

What positions can the appendix occupy relative to the caecum, as shown in this figure?

Retrocecal ($64\%$–$74\%$), pelvic ($32\%$–$21\%$), subcecal, preileal ($1\%$), postileal ($0.5\%$), and paracecal ($2\%$).

Why is the tip of the appendix the most common site for gangrene and perforation in acute appendicitis?

The appendicular artery is a terminal artery whose distal portion runs in close contact with the appendiceal wall, making it vulnerable to thrombosis during inflammation.

What is the most common cause of obstructive acute appendicitis?

A faecolith.

What is Rovsing's sign?

Pain elicited in the right lower quadrant (RLQ) upon deep palpation of the left lower quadrant (LLQ).

Which physical examination sign for acute appendicitis is illustrated in this diagram?

Rovsing's sign.

What clinical test is depicted, and what appendiceal position does a positive test indicate?

Psoas sign (pain on passive right hip extension), which indicates a retrocaecal appendix.

What clinical examination sign is shown, and what position of the appendix does it suggest?

Obturator sign (pain on passive internal rotation of the flexed right hip), indicating a pelvic appendix.

Why does acute appendicitis carry an $80\%$ perforation rate in children under $3$ years of age?

Due to difficulty of abdominal examination in young children, an underdeveloped greater omentum that fails to wall off infection, and misdiagnosis as gastroenteritis.

In the Alvarado scoring system, which two features are assigned $2$ points each?

Tenderness in the right lower quadrant and Leukocytosis ($> 10,000/mm^3$).

What clinical course is indicated for a patient with an Alvarado score of $7$ or higher?

Surgery (appendectomy).

What open appendectomy incision is shown in this diagram?

Gridiron incision (McBurney incision).

What type of open appendectomy incision is depicted in this diagram?

Lanz incision (transverse or skin crease incision).

What is the most common postoperative complication following an appendectomy?

Wound infection.

What is the standard initial management for an appendicular mass?

Conservative management using the Ochsner–Sherren regime (bed rest, NPO, IV fluids, IV antibiotics, and close monitoring), followed by interval appendectomy after $3$ months.

Which clinical findings indicate that conservative management of an appendicular mass has failed and an abscess has formed?

A rising pulse rate, increasing temperature, spreading abdominal pain, and an increasing mass size.

What is the proper management for an incidental appendiceal carcinoid tumor measuring less than $2\,cm$ confined to the tip?

Simple appendectomy.

What surgical procedure is required for an appendiceal adenocarcinoma or a carcinoid tumor larger than $2\,cm$?

Right hemicolectomy.

Which urinary metabolite confirms the diagnosis of carcinoid syndrome?

5-hydroxyindoleacetic acid (5-HIAA).