SEARCH RESULTS FOR: Appendicitis

perforated-viscous

Perforated “Viscous” (aka. GI tract; bowels): Author: Yan Yu Reviewers: Michael Blomfield, Tony Gu, Dean Percy, Danny Guo Maitreyi Ramran* * MD at initial time of publication Chest X-Ray (CXR) Pathogenesis and Clinical Findings Diverticulitis Crohn’s disease Peptic ulcer (H. pylori infection, NSAID use, ICU stress, etc) Appendicitis Malignant neoplasm Irritates visceral peritoneum, stimulates autonomic nerves Severe inflammation causes destruction of GI tract mucosa Over time, Perforation of the GI tract wall Bowel contents (air, fluids) released into peritoneal cavity Massive peritoneal inflammation Diagnostic investigations if a GI perforation is suspected Dull diffuse abdominal pain Severe, Sharp abdominal pain with peritoneal signs Abdominal X-ray Irritation of parietal peritoneum, stimulates somatic nerves • Abdominal X-ray • Intra-peritoneal air will coat the GI tract surfaces, giving them a faint white outline under X-ray • Chest X-ray of upright patient (Diagnostic) • Intra-peritoneal air will rise above the peritoneal fluid when pt is upright, accumulating under the right hemi-diaphragm. • Note: air under left hemi-diaphragm = normal gastric bubble • CT? Most patients with suspected GI perforation will get a CT scan, but this is not the diagnostic gold standard (and access to CT can be limited, especially in rural settings) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Re-Published June 30, 2019 on www.thecalgaryguide.com

Appendicitis

Appendicitis: Pathogenesis and Clinical Findings Authors: Yan Yu Wayne Rosen* Reviewers: Wendy Yao Laura Craig Noriyah AlAwadhi* * MD at time of publication Dull, crampy, diffuse peri- umbilical pain Pt may develop fever, diarrhea, constipation, vomiting or anorexia as inflammation worsens Focal, intense, persistent RLQ pain, abdominal guarding and peritoneal signs (i.e. percussion and rebound tenderness Epidemiology Dx of healthy adults: • Men > women • Commonly 10-30 years old, can present at any age • Most common cause of acute abdomen (5% prevalence in all ethnicities) The appendix is anatomically located in the RLQ; appendicitis may be confused with disorders of surrounding structures: Gynecological Diseases • RuleoutpregnancywithHCG pregnancy test • Rupturedovariancyst • Ectopicpregnancy • Mittelschmerz(mid-cycle pain) Gastro-intestinal Diseases • Meckel’sdiverticulum (presents identically to appendicitis; surgically located 2 feet from ileocecal valve; mostly seen in children) • Diverticulitis(presentsasleft sided appendicitis) Non-GI Abdominal Issues • Mesentericadenitisinkids <15: swollen mesenteric lymph nodes • Renalcolic Obstruction of appendiceal lumen (by fecalith, fibrosis, neoplasia, foreign bodies or lymph nodes in kids) Appendix distension and spasms ↑ lumen pressure, ↓ blood flow to appendix Ischemia, tissue necrosis, loss of appendix structural integrity Bacterial invasion of the appendix wall, causing transmural inflammationandnecrosis Stretching of visceral peritoneum, stimulation of autonomic nerves T9-T10 Progression of inflammation over several days (variable length of time) Irritation of parietal peritoneum, stimulation of somaticnerves If appendix not surgically removed Perforation of colon wall, causing peritonitis, abscesses or death Note: Symptoms hugely variable. Only 30% present with classic history. Diagnosis is mostly clinical. Further investigations: CBC: Leukocytosis (due to inflammatory response) CT: Gold standard test. Thickened visceral membrane with enhancing (white) rim due to ↑ blood flow Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Re-Published July 27, 2019 on www.thecalgaryguide.com

Acute GI Related Abdominal Pain

Acute GI-Related Abdominal Pain: Pathogenesis and Characteristics Authors: Yan Yu Wayne Rosen* Reviewers: Laura Craig Danny Guo Julia Heighton Maitreyi Raman* * MD at time of publication Peritoneal cavity Visceral peritoneum (innervated by autonomic nerves) Bowel stretching, pulling, contracting Abdominal pain type: Diffuse, non-localized Dull, crampy, periodic Not associated with movement Patient may writhe around, trying to get rid of the pain Mesentery Intestinal lumen Parietal peritoneum (innervated by somatic nerves) Cross-section of the GI tract Cuts, structural damage, and inflammation in the bowel Important Notes • Acute abdominal pain can also result from non- gastrointestinal causes, such as kidney stones, female reproductive tract issues, and urinary tract issues. For simplicity’s sake, only the GI-related acute abdominal pain disorders are listed here. • The DDx of visceral abdominal pain is broad. Please consult relevant sections of the Calgary Black Book for the DDx. • Keep in mind that visceral abdominal pain can also be caused by the “acute abdomen” diseases (if the diseases are presenting in their initial phases). • • • • • • Abdominal pain type: Sharp, well-localized Excruciatingly painful, persistent Associated with movement of bowels Patient often lies still to avoid abdominal vibration Peritoneal signs Abdominal guarding, pain with abdominal vibration (coughing, shaking, percussion, palpation) Transition from diffuse to localized pain can indicate disease progression (e.g. from visceral to parietal peritoneal inflammation) Note: bowel obstruction may or may not present as acute abdominal pain Bowel Infarction Appendicitis Diverticulitis Acute Cholecystitis Acute Pancreatitis Perforated Ulcer DDx of an “acute abdomen”: A sudden, non-traumatic disorder of the abdomen that needs urgent diagnosis and treatment. Each topic will be further explored in their respective slides. Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Re-Published July 27, 2019 on www.thecalgaryguide.com

apendicitis-patogenesis-y-hallazgos-clinicos

apendicitis-patogenesis-y-hallazgos-clinicos