41.most common symptom of appendicitis is ? fmge march 2012
a.pain
b.headache
c.nausea
d.anorexia
answer: a
The classical symptoms of acute appendicitis are
epigastric or periumbilical pain followed by brief nausea, vomiting, and anorexia; after a few hours, the pain shifts to the right lower quadrant. Pain increases with cough and motion. Classic signs are right lower quadrant direct and rebound tenderness located at McBurney's point (junction of the middle and outer thirds of the line joining the umbilicus to the anterior superior spine).
Additional signs are pain felt in the right lower quadrant with palpation of the left lower quadrant (Rovsing sign), an increase in pain from passive extension of the right hip joint that stretches the iliopsoas muscle (psoas sign), or pain caused by passive internal rotation of the flexed thigh (obturator sign).
questions on appendicitis
Questions
Q1. Which of the following is the least common position of appendix?
a) Retroileal
b) Retroceacal
c) Postileal
d) Pelvic
Q2. Most Common malignancy of appendix is?
a) Carcinoid Tumor
b) Adenocarcinoma
c) Squmaous Cell carcinoma
d) MIxed Cellularity
Q3. All are features of Acute Appendicitis on Ultrasound examination except?
a) A compressible blind ending tube
b) Diameter of more than 7 mm
c) Loss of submucosal echogenicity
d)
Q4. What is not true as differential diagnosis for appendicits in the elderly
a) Adenocarcinoma appendix
b) Diverticulitis
c) Pyelonephritis
d) Colitis
Q5. Not true about appendicitis in pregnancy?
a) Risk of appendicitis in pregnancy remains the same as in non pregnant woman of same age group.
b) Appendicitis ocurs more commonly in the 1st two trimesters.
c) The effect of negative laparotomy for appendicitis in pregnant patient is significant
d) Early appendectomy is the appropriate therapy in suspected appendicitis during all stages of pregnancy.
Answers
1.a
The positions of the appendix are
1. Retrocecal - Posterior to the cecum and lower part of the ascending colon
2. Pelvic /Descending Descending over the pelvic brim
3. Subcecal Below the cecum
4. Preileal Anterior to the terminal ileum and in relation to the anterior abdominal wall
5. Postileal Posterior to the terminal ileum
2. b
It was previously believed that carcinoid tumors are the most common tumors of the appendix ( Sabiston 17th) but now data from SEER ( Surveillane, epidimology and End results) show that mucinous adenocarcinomas are more common
Sabiston 18th page 1344.
3.
All these are true
4.a)
Altough adenocarcinoma of appendix can present as appendicitis, it is never kept as a differential diagnosis when appendicits is contemplated
5. c
The risk of negative laparotomy in suspected appendicitis in pregnancy is minor. However a ruptured appendicitis could be catastrophic. Early diagnosis and surgery for appendicitis should be performed in pregnancy.
There may be diagnostic confusion as during the third trimester of pregnancy, the cecum and appendix are displaced laterally and are rotated by the enlarged uterus. Pain occurs more laterally in the flank, leading to delay in diagnosis and an increased incidence of perforation.
Study Notes
McBurney's point, the junction of the lateral and middle thirds of the line that joins the right anterior superior iliac spine to the umbilicus, is used as a surface marking for the base of the appendix. The three teniae coli converge at the tip of the cecum to form the continuous longitudinal muscle layer of the appendix. The base of the appendix can be located by tracing the anterior taenia coli to the tip of the cecum. The ileocecal fold of peritoneum, which connects the terminal 2.5 cm of ileum to the cecum, can also be used to locate the base of the appendix. A short, triangular mesoappendix extends along the length of the appendix and connects it to the lower portion of the mesentery of the ileum.
