MC bacteria isolated in perforated appendicitis?
Bacteroides fragilis (80%) > E. coli (77%)
Pain on coughingQ
Pain in the right lower quadrant during palpation of the left lower quadrantQ
- Pain on internal rotation of the hipQ
- Suggestive of pelvic appendixQ
- Pain on extension of the right hipQ
- Suggestive of retrocecal appendixQ
Characteristic findings of acute appendicitis?
Appendix ≥ 7 mm diameter, a thick-walled, noncompressible luminal structure seen in cross section (target lesion), or the presence of an appendicolithQ
Risk Factors for Appendicular Perforation?
- [@ Fecolith DIE in Pelvic Surgery]
- • FecolithQ
- • Diabetes mellitusQ
- • ImmunosuppressionQ
- • Extremes of agesQ
- • Pelvic appendixQ
- • Previous abdominal surgeryQ
What is Bastedo sign?
- • An obsolete sign in chronic appendicitisQ
- • Pain and tenderness in right iliac fossa on inflation of the colon with airQ
Alvarado Scores for acute appendicitis?
- 9–10 - Appendicitis is certain
- 7–8 - High likelihood of appendicitis
- 5–6 - Equivocal
- 1–4 - Appendicitis can be ruled out
Causative organism for acute mesenteric lymphadenitis?
Treatment of acute appendicitis in pregnancy?
- Early appendectomyQ is the appropriate therapy in suspected appendicitis during all stages of pregnancy.
- Laparoscopic appendectomy is safeQ
What is Alder’s Test?
- • Localizing the area of maximal abdominal tenderness and maintaining constant pressure on that point while the patient is being turned to leftQ.
- • If the pain is constant, pain is of extra-uterine origin; if pain disappears it is more likely to be uterine or tubal originQ.
- • This is a very useful and important clinical test which may be employed in all cases of an acute abdomen in pregnancyQ
Criteria for stopping conservative treatment of an appendix mass?
- • A rising pulse rateQ
- • Increasing or spreading abdominal painQ
- • Increasing size of the massQ
• MC neoplasm of appendix?
(MAC): Mucinous adenocarcinomaQ (38%) > Adenocarcinoma (26%) > Carcinoid (17%).
MC malignant neoplasms of the small bowel?
Carcinoid tumorsQ > adenocarcinomas > malignant GISTs > lympho
Gross appearance of Appendiceal Carcinoid?
Firm, yellow, bulbar mass in the appendix, majority are located in tip of appendix
Treatment of Appendiceal Carcinoid?
- Up to 1 cm• AppendectomyQ
- > 1–2 cm
- • Appendectomy if located at tip or mid-appendix
- • Right hemicolectomy if: −−Located at baseQ−−Invading mesoappendixQ −−LN involvementQ
- > 2 cm• Right hemicolectomyQ
Treatment of Mucocele appendix?
- Every effort is made to keep the mucocele intact during extraction, including placing the specimen in a bag or converting a laparoscopic procedure to an open procedureQ, if necessary.
- Appendectomy + Wide resection of the mesoappendix to include all the appendiceal lymph nodes + Collection and cytologic examination of all intraperitoneal mucus + Inspection of the base of the appendixQ.
- Right hemicolectomy is reserved for patients with a positive margin at the base of the appendix or positive periappendiceal lymph nodesQ.
Treatment of appendiceal adenocarcinoma?
Difference between McArthurQ and Rutherford incision?
- McArthur – No muscle incision
- Rutherford Morison - incisionQ by cutting the internal oblique and transversus muscles.
- In McBurney’s incision, incision is extended upwards and laterally, not downwards.
Prevention of Stump Appendicitis?
Residual appendiceal stump should not be more than 3mmQ
Which nerve is responsible for inguinal hernia after appendectomy?
IH → IH (IlioHypogastric nerve → Inguinal Hernia
What is Mitrofanoff procedurQ?
Urologic reconstruction as an appedicovesicostomy in patients requiring chronic catheterization for bladder emptying
What is Malone ProcedureQ?
Conduit for decompression after colon surgery or for the chronic administration of medications or enema