Appendicitis
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Acute appendicitis is caused by luminal obstruction of the vermiform appendix, most commonly by a fecalith. Clinical features include periumbilical or right lower quadrant pain, anorexia, nausea, and tenderness in the right lower quadrant. The Alvarado score is used to determine the likelihood of appendicitis and need for imaging or surgical consultation. For patients presenting with suspected appendicitis, ultrasound is usually the initial imaging choice, while CT is also effective for diagnosis. Surgery is the standard treatment for confirmed acute appendicitis.
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This document summarizes appendicitis, including the anatomy of the appendix, aetiology, clinical presentation, diagnosis, and treatment. Key points include:
- The appendix is a tubular structure located in the lower right abdomen that can become inflamed (appendicitis).
- Appendicitis is caused by obstruction of the appendix lumen, often by a fecolith. Common symptoms include abdominal pain that starts around the navel and moves lower.
- Diagnosis is usually clinical but can be supported by blood tests showing leukocytosis and imaging like CT scans. Treatment involves intravenous fluids, antibiotics, and an appendectomy to remove the appendix.
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Appendicitis PPT By Dr Anil Kumar, Assist Professor,Gen Surgery, AIIMS-Patna
This document provides an overview of the anatomy, pathology, clinical presentation, diagnosis, and treatment of acute appendicitis. Key points include:
- The appendix is typically located retrocecally and ranges from 2-20cm in length. Acute appendicitis is usually caused by obstruction of the appendicular lumen.
- Clinical features include migratory pain, anorexia, nausea, and localized tenderness in the right lower quadrant. Alvarado scoring helps diagnose appendicitis.
- Treatment involves antibiotics, analgesia, and appendectomy within 24 hours for acute appendicitis. The Ochsner-Sherren regimen is used conservatively for appendicular lumps.
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This document summarizes appendicitis, including the anatomy of the appendix, aetiology, clinical presentation, diagnosis, and treatment. Key points include:
- The appendix is a tubular structure located in the lower right abdomen that can become inflamed (appendicitis).
- Appendicitis is caused by obstruction of the appendix lumen, often by a fecolith. Common symptoms include abdominal pain that starts around the navel and moves lower.
- Diagnosis is usually clinical but can be supported by blood tests showing leukocytosis and imaging like CT scans. Treatment involves intravenous fluids, antibiotics, and an appendectomy to remove the appendix.
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Appendicitis PPT By Dr Anil Kumar, Assist Professor,Gen Surgery, AIIMS-Patna
This document provides an overview of the anatomy, pathology, clinical presentation, diagnosis, and treatment of acute appendicitis. Key points include:
- The appendix is typically located retrocecally and ranges from 2-20cm in length. Acute appendicitis is usually caused by obstruction of the appendicular lumen.
- Clinical features include migratory pain, anorexia, nausea, and localized tenderness in the right lower quadrant. Alvarado scoring helps diagnose appendicitis.
- Treatment involves antibiotics, analgesia, and appendectomy within 24 hours for acute appendicitis. The Ochsner-Sherren regimen is used conservatively for appendicular lumps.
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1. Acute appendicitis is caused by obstruction of the appendix lumen, leading to increased intraluminal pressure, edema, and bacterial invasion.
2. The classic presentation includes initially vague periumbilical pain that later localizes to the right lower quadrant, accompanied by anorexia, nausea, and low-grade fever.
3. On examination, tenderness is elicited over McBurney's point with guarding and rebound tenderness. Diagnosis is suggested by clinical scoring systems and confirmed by ultrasound or CT scan showing a thick-walled, inflamed appendix.
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1) Inguinal hernias are common, with approximately 700,000 repairs performed annually in the US, mostly occurring in males.
2) There are two main types of inguinal hernias - indirect and direct. Indirect hernias are congenital while direct hernias are acquired lesions that occur through the posterior inguinal wall.
3) Common surgical repair options include the Lichtenstein tension-free repair using mesh, the Shouldice repair with overlapping tissue layers, and laparoscopic repairs like TAPP and TEP which utilize a mesh placed laparoscopically.
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Acute appendicitis is inflammation of the appendix that is commonly caused by obstruction. It occurs in about 10% of the population between ages 10-20 but can occur at any age. The obstruction leads to bacterial proliferation, invasion of the appendix wall, and damage from pressure necrosis. Initial pain is periumbilical but shifts to the right lower quadrant as the inflamed appendix touches the peritoneum. Signs include maximum tenderness, guarding, and rebound tenderness in the right iliac fossa. The Alvarado score is used to evaluate the likelihood of appendicitis. Treatment is antibiotic therapy and an appendectomy.
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The most important distinction between collections in necrotizing pancreatitis and those associated with acute IEP is the presence of nonliquefied material in collections due to necrotizing pancreatitis.
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1) The document provides guidelines for performing an abdominal examination, including inspection, palpation, percussion, and auscultation.
2) Seven sample patient cases are described to demonstrate how findings from the abdominal exam can be used to arrive at diagnoses. Diagnoses included fatty liver, splenomegaly, sigmoid carcinoma, ascites, hydronephrosis, carcinoid tumor, and schwannoma.
3) Performing a thorough abdominal exam through inspection, palpation, percussion, and auscultation is important for identifying abnormalities and arriving at accurate diagnoses.
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Acute appendicitis is caused by obstruction of the appendix lumen, which increases intraluminal pressure and leads to tissue ischemia, necrosis, and potential perforation. It presents with initially vague periumbilical pain that migrates to the right lower quadrant. Diagnosis is suggested by tenderness over McBurney's point on exam. Imaging such as CT can help diagnosis but is not always needed. Treatment is appendectomy with preoperative antibiotics. Patients may be observed briefly if diagnosis is uncertain.
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1. Acute appendicitis is caused by obstruction of the appendix lumen, leading to increased intraluminal pressure, edema, and bacterial invasion.
2. The classic presentation includes initially vague periumbilical pain that later localizes to the right lower quadrant, accompanied by anorexia, nausea, and low-grade fever.
3. On examination, tenderness is elicited over McBurney's point with guarding and rebound tenderness. Diagnosis is suggested by clinical scoring systems and confirmed by ultrasound or CT scan showing a thick-walled, inflamed appendix.
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Gastrointestinal perforation can be caused by a variety of illnesses and medical conditions that damage the intestinal wall such as appendicitis, diverticulitis, ulcers, gallstones, inflammatory bowel diseases, abdominal trauma, surgery, and foreign object ingestion. Symptoms include severe abdominal pain, fever, nausea, vomiting, and rectal bleeding. Diagnosis involves x-rays, CT scans, and lab tests. Treatment is usually surgery to repair the perforation and address underlying causes, though sometimes antibiotics alone may be used if the perforation has closed. Complications can include bleeding, infection, abscesses, and permanent colostomies. Prognosis depends on early diagnosis and treatment as well as individual risk factors
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Acute appendicitis is inflammation of the appendix that is commonly caused by obstruction. It occurs in about 10% of the population between ages 10-20 but can occur at any age. The obstruction leads to bacterial proliferation, invasion of the appendix wall, and damage from pressure necrosis. Initial pain is periumbilical but shifts to the right lower quadrant as the inflamed appendix touches the peritoneum. Signs include maximum tenderness, guarding, and rebound tenderness in the right iliac fossa. The Alvarado score is used to evaluate the likelihood of appendicitis. Treatment is antibiotic therapy and an appendectomy.
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In acute IEP, collections that do not have an enhancing capsule are called APFCs; after development of a capsule, they are referred to as
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Portal hypertension is defined as elevated portal pressure above 10-12 mm Hg. It is classified as pre-hepatic, intra-hepatic, or post-hepatic based on the location of blockage. Common causes include liver cirrhosis and blockages in the portal vein. Clinical features include upper GI bleeding, splenomegaly, ascites, and hepatic encephalopathy. Management involves treating acute bleeding episodes endoscopically and use of beta-blockers for prevention, along with diuretics and paracentesis for ascites. More advanced treatments include TIPSS, surgical shunting, and liver transplantation.
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1. An umbilical hernia is a protrusion of abdominal contents through the abdominal wall near the umbilicus.
2. It can be congenital, due to incomplete closure of the umbilical ring, or acquired later in life due to risk factors like obesity, pregnancy, or ascites.
3. Physical exam reveals a soft, reducible mass at the umbilicus that increases in size with straining; complications include incarceration or strangulation which require surgery.
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Clinical Cases in Gastroenterology and Hepatology
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acuteappendicitis
This document discusses acute appendicitis, including its pathophysiology, diagnosis, treatment, and disposition. The key points are:
1. Acute appendicitis is caused by obstruction of the appendix lumen, leading to increased intraluminal pressure, vascular compromise, and eventually perforation.
2. The classic presentation of abdominal pain migrating from the periumbilical region to the right lower quadrant is seen in about half of patients. Physical exam may reveal tenderness at McBurney's point.
3. Diagnosis is suggested by symptoms and confirmed through blood tests, urine analysis, and imaging studies like CT scans or ultrasounds. Treatment is an appendectomy along with pre
Emergency Ultrasound Course -Lecture 04 -Acute Appendicitis -Part 3
This document provides an overview of emergency ultrasound for acute appendicitis. It discusses the post-appendectomy status, including the appearance of the appendiceal stump at various time points after surgery. It also reviews complications of appendicitis and appendectomy such as abscesses. The document presents several case studies demonstrating ultrasound findings for acute appendicitis and unusual cases, including appendicitis in hernias. It concludes with a discussion of conditions that can mimic the symptoms of appendicitis.
class acute abdomen other causes.pdf PPT.pdf
This document discusses various causes of acute abdominal pain, including non-specific abdominal pain (34%), acute appendicitis (28%), acute cholecystitis (10%), small bowel obstruction (4%), perforated peptic ulcer (3%), pancreatitis (3%), and diverticular disease (2%). It describes the pathophysiology of visceral, parietal, and referred pain. It provides details on localized pain patterns from various abdominal organs and conditions. It also outlines the important history, physical exam findings, and initial investigations for evaluating a patient with acute abdominal pain.
Case presentation- Internal hernia-1.pptx
This document presents a case study of a 46-year-old man admitted with abdominal pain, vomiting, and signs of intestinal obstruction. Imaging revealed fluid levels in the small bowel and herniation of the jejunum within an abnormal sac-like structure. At surgery, the herniated small bowel was found viable and reducible. The sac was resected without need for bowel resection. The patient recovered well and was discharged on post-op day four. This case demonstrates an internal hernia as a cause of small bowel obstruction.
Acute appendicitis
Acute appendicitis - inflammation of the vermiform appendix.
Epidemiology, diagnosis, clinical features, pathology/morphology, pathogenesis/pathophysiology, investigations, management, non-surgical - non-pharmacological, pharmacological, and surgical treatment approach.
Caso ciego 7 de mayo de 2013
A 17-year-old boy presented with 6 weeks of abdominal pain and unintended weight loss. Imaging showed irregular narrowing in the cecum and peritoneal implants throughout the abdomen. During his hospitalization, the patient developed a fever and CT scans showed a mediastinal mass and multiple lung nodules. Biopsies of the mediastinal mass and peritoneal implants were performed to determine the cause of the patient's symptoms and abnormal imaging findings.
ABDOMINAL TRAUMA in pediatrics part one.
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
appendix7.pptx
The 15-year-old boy presented with gradually worsening lower right abdominal pain for 4 days, along with nausea, vomiting, and loss of appetite. On examination, he had tenderness in the right iliac fossa and rebound tenderness. Acute appendicitis should be considered, as the presentation is consistent with the classic progression of abdominal pain from periumbilical to localized right lower quadrant pain, along with common associated symptoms of anorexia, nausea, and vomiting. Laboratory tests such as a CBC can help evaluate for elevated white blood cells, though the diagnosis of appendicitis is primarily based on the history and physical exam findings.
Acute abdomen – general principles and approach in ED
A 35-year-old man presents to the emergency room with 3 days of crampy abdominal pain and diarrhea. On examination, he is tender to palpation in all abdominal quadrants but has no rebound or guarding. Acute abdomen refers to sudden severe abdominal pain of unclear cause lasting less than 24 hours that requires urgent intervention. It accounts for 10-15% of emergency room visits and almost 40% require surgery. Initial assessment of a patient with abdominal pain includes vital signs, inspection, palpation, and laboratory tests to determine the cause and severity of the condition and whether surgical intervention is needed.
Appendicitis
Mr. Y, a 20-year-old male, presented with sudden sharp abdominal pain on the right lower quadrant for several hours. His symptoms included vomiting and a high pain rating. On examination, he had guarding and tenderness in the right lower quadrant. Tests showed an elevated white blood cell count. He was diagnosed with acute appendicitis and underwent an open appendectomy. During surgery, his appendix was found to be inflamed. He was treated post-operatively with antibiotics and pain medication.
Acute appendicitis
Acute appendicitis is caused by obstruction of the appendix lumen, which increases intraluminal pressure and leads to vascular compromise and tissue necrosis. Initial symptoms are vague abdominal pain that localizes to the right lower quadrant as inflammation spreads. A physical exam may reveal tenderness at McBurney's point. Imaging studies like CT scans can help diagnose appendicitis, especially in atypical cases. Treatment is an appendectomy along with preoperative antibiotics to prevent infection.
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Appendicitis
- 1. Acute Appendicitis Dr Bahauddin Baha, Resident Emergency Physician.
- 2. PATHOPHYSIOLOGY luminal obstruction of the vermiform appendix. • Most Frequent: Fecalith. • Less common: obstruction by lymphatic tissue, gallstone, tumor, or parasites.
- 3. Clinical Features. • In early stage generalized malaise. • Bowel Irregularity. • Anorexia (Common one) • Periumbilical or central abdominal pain after nonspecific signs. • Nausia, vomiting doesn’t have to be present always. • Fever • Pain Migration to RLQ • Right Lower Quadrant Tenderness. • Rovsing’s sign
- 4. What other signs ?
- 5. • A 32 years old patient came to Emergency Room with loss of appetite and feeling nauseated, followed by pain which started in umbilical region and localized between Right side anterior superior iliac spine and umbilicus. He has done CBC test outside which shows leukocyte count of 13500. On examination you find out that he has temperature of 100F, tenderness in RLQ plus rebound tenderness.
- 6. Alvarado score (MANTRELS) • Migration of Pain to RLQ: 1 • Anorexia/Urine Acetone:1 • Nausia/Vomiting: 1 • Tenderness in RLQ: 2 • Rebound Pain: 1 • Elevated Tempreture: 1 • Leukocytosis: 2 • Shift of WBC to the Left: 1
- 7. In a class III study of ACEP Clinical Policy to develop guidelines for CT. • Score of 3 or less 5% 4-6 36% 7 or Higher 78% • Conclusion Patients with scores of 3 or less should not have CT. • Those with score of 4-6 should under go a CT. • 7 or Higher would benefit from surgical consultation. • In another Class III study, found that no patients with Alvarado scores below 5 had appendicitis. • In 2 other studies the authors recommended imaging even patients with low Alvarado scores.
- 8. Imaging. • Obtain early surgical consultation before imaging in straightforward cases of suspected appendicitis in adults. • Graded compression US should be the initial imaging modality of choice in both pregnant females37 and children and in young, nonobese adults. • Typical findings in appendicitis are a thickened, noncompressible appendix >6 mm in diameter.
- 9. • Abdominopelvic CT. Dilated appendix >6 mm with a thickened wall, periappendiceal inflammation, and potential visualization of an appendicolith or abscess. • Oral and IV Contrast versus Nonenhanced CT. Multiple studies indicate that nonenhanced CT has excellent performance in the diagnosis of acute appendicitis.
- 10. • An 18-year-old male presents with abdominal pain that began approximately 8 hours ago. Initially, he experienced nausea with periumbilical pain that is now primarily in the right lower quadrant. He has never been hospitalized or had any surgeries. On exam, his temperature is 100.6◦F, and his abdominal exam reveals tenderness at McBurney’s point. What should be the next step? • • (A) CBC and urinalysis • (B) CTscan of the abdomen/pelvis • (C) Plain films of the abdomen • (D) Surgical consultation • (E) Ultrasound of the abdomen
- 11. DISPOSITION AND FOLLOW-UP • Surgery is the accepted standard of care for acute appendicitis. • Can schedule a Patient for reevaluation after 12 hours.