Topic 3 acite abdomen 1

Acute appendicitis/peritonitis definition & etiology

Acute inflammation of the vermiform appendix.

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Etiology:
Intraluminal - foreing body, parasites
intramural - lymphoid hyperplasia, virus
extraluminal - trauma,
citi - pollution

Pathogenesis
Obstruction of appendiceal lumen → increasing intraluminal pressure of appendix → venos stasis of appendix wall → breakdown of mucosal barrier → intraluminal bacterial overgrowth and invasion of appendix wall → inflammation

Acute appendicitis classification

Clinical manifistation - Acute, chronic

Histology - acute focal/catarrhal, acute suppurative/phlegmonous, gangrenous, perforative, neirogenic

Uncomplicated: acute focal, suppurative
Complicated: gangrenous, perforative

Local, diffuse

Acute appendicitis diagnostics

Rebound tenderness

CBC:WBC, ANC, IL-6, CRP, procalcitonin, leukocytosis

US (diameter, thickness, compressibility),

CT, MRI, Xray, abdomen

laparoscopy

(alvarado score)

Acute appendicitis Sympoms

Anxiety, low activity

vomiting, diarrhea, anorexia, nausea, fever
Abdominal pain

faster in small children, US dont show apendix wall

Acute appendicitis treatment

uncomplicated: No feeding 12h, IV antibiotics 3 days, analgesia

Ineffective for 24-48h or complicated → surgery

laparoscopic appendectomy

GI beelding differential diagnosis

stress gastritis, coagulopathies, anal fissure

esophagitis, gastritis, intussusception, gangrenous bowel, milk protein allergy

peptic ulcer disease, gastritis, polyps,

Meckels diverticulum definition

congenital remnant of vitelline duct (connecting that connected midgut and yolk sac in embryo)

Meckels diverticulitis picture, as intestine is inflamed, so mass texture differes from intestine

Meckels diverticulum signs

asymptomatic

GI bleeding with melena

chronic anemia, abdominal pain

subocclusion/occlusion of small intestine

GI endoscopy
Xray indirect signs, US
meckels scan

Send tissue to pathology

meckels divertulum picture - mass is same as intestine

Meckels diverticulum treatment

Blood transfusion, profylactic antibiotics pre surgery

gastrointestinal anastomosis → parenteral feeding until bowel motion resumes

surgery laporascopy (diverticulectomy or segmental ileal resection with primary anastomosis.)

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GI bleeding treatment goals
ensure patient stability
establish adequate oxygen delivery
intravenous access
fluid and blood resuscitation
correct coagulopathies

Intususception definition & etiology

Telescoping of one bowel segment into another.
Etiology: idiopathic or meckels diverticulum

Intussusception sympoms

ombredanne triad - Abdominal pain - Vomiting - Currant jelly stool

palpable sausage shaped mass

Intussusception diagnostics

Abdominal ultrasound - gold standard

CBC, BMP, CRP - Contrast enema - X-ray —> Exclude perforation

intussusception treatment & complications

concervative reduction - enema/Pneumatic/hydrostatic reduction

Surgery: Laparotomy or laparoscopic reduction

complications: Bowel ishemia, perforatoin