Neurosciences and diseases of the mind
R. Paul Thompson, Ross E.G. Upshur in Philosophy of Medicine, 2017
Appendicitis is a good case study because diagnosis is more complicated than a fractured tibia but less complicated than some other physical disorders, such as liver diseases. What this case illustrates is that with physical disorders, there is a determinable cause. It may take a skilled diagnostician to ask the appropriate questions, to perform an informative physical examination and to request the relevant tests, but the cause can be identified with considerable accuracy. False positive diagnoses and false negative diagnoses do occur but are uncommon. Once the diagnosis has been made, the treatment is uncontroversial and successful in almost all cases. Complications occur when there are other disorders along with the appendicitis or the appendix has ruptured. But even then, the treatment regime is clear.
Appendicitis
Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba in Acute Care Surgery and Trauma, 2016
Deviations from these commonly associated physical findings usually are related to the anatomic position of the inflamed appendix. The common anatomic locations of the appendix include: paracolic (the appendix lies in the right paracolic gutter lateral to the cecum), retrocecal (the appendix lies posterior to the cecum and may be partially or totally extraperitoneal), preileal (the appendix is anterior to the terminal ileum), postileal (the appendix is posterior to the ileum), promontoric (the tip of the appendix lies in the vicinity of the sacral promontory), pelvic (the tip of the appendix lies in or toward the pelvis), and subcecal (the appendix lies inferior to the cecum) [11]. Wakeley [12] performed a postmortem analysis of 10,000 cases and described the frequency of the location of the appendix as follows: retrocecal, 65.3%; pelvic, 31%; subcecal, 2.3%; preileal, 1%; and right paracolic and postileal, 0.4%. When the appendix occupies an unusual location the diagnosis of appendicitis can be more difficult and may contribute to delays in presentation, diagnosis, and treatment.
Anatomy
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
The appendix is a narrow muscular tube containing a large amount of lymphoid tissue that can vary markedly in length and position. The appendiceal base is attached to the posteromedial aspect of the caecum, but the tip is free and is subject to considerable positional variation as a result. In broad terms, the following positions are found at surgery: retro-caecal (~65%–70%), pelvic (25%–30%) and pre- or retro-ileal (~5%). This variability in anatomical location can lead to a variable clinical picture as a consequence of acute appendicitis. Consequently, patients with pelvic appendicitis or retrocaecal appendicitis may not develop right iliac fossa peritoneal irritation.
Bite-sized learning: Response to ‘Twelve tips for optimising learning for postgraduate doctors in the operating theatre’
Published in Medical Teacher, 2023
Raghav Vinay Aggarwal, Jasleen Kaur Gabrie
To address these challenges, we suggest offering a more concise learning experience. For example, illustrating how a laparoscopic appendicectomy can be broken down into more manageable components could allow trainees to determine defined learning outcomes. Let’s divide the example procedure into five stages, with associated ‘micro’ learning objectives:Pre-Operative Preparation: Sterile Technique, Scrubbing in, Theatre Briefings, Patient Positioning.Trocar Placement & Laparoscopic Instruments: Principles of Trocar Placement, Handling Laparoscopic Instruments.Surgical Anatomy: Identifying the Appendix and Surrounding Structures.Appendectomy: Technique for dissecting and isolating the appendix from surrounding tissue.Closure & Post-Operative Care: Port Site Closure (including suturing), Post-operative care.
Management of mucocele of the appendix with peritoneal dissemination in pregnant women: a case report and literature review
Published in Acta Chirurgica Belgica, 2023
Sophiane Derbal, Clemence Klapczynski, Aurélie Charissoux, Sylvaine Durand Fontanier, Abdelkader Taibi
Second, AM is often diagnosed on routine abdominal ultrasound. However, in pregnant women it should also be characterised by abdominal diffusion-weighted MRI according to the RENARAD protocol [10]. A further advantage of this imaging exam is its ability to detect pools of mucin, especially in areas that are difficult to access in pregnant patients, and its good sensitivity in analyses of the cellularity, including in determination of the PCI and the detection of mucin pools [11,12]. According to literature reports, in patients with AM discovered fortuitously during pregnancy, appendectomy was performed after childbirth, given the risk of miscarriage and the slow progression of the pathology [13]. In our opinion, in a pregnant patient, if the progression of AM is slow (AM without perforation) or moderate (AM with acellular mucin), the pregnancy should be allowed to proceed to a vaginal delivery. In this case, acellular mucin is re-absorbed and does not lead to PMP. Nevertheless, the absence of epithelial cells outside the appendix is key.
Safety and efficacy of short-course intravenous antibiotics after complicated appendicitis in selected patients
Published in Acta Chirurgica Belgica, 2023
Hidde M. Kroon, Tim Kenyon-Smith, Gavin Nair, James Virgin, Bev Thomas, Karolina Juszczyk, Paul Hollington
The FMC appendicitis protocol (Appendix A) states that patients who present to the Emergency Department (ED) with a suspected appendicitis undergo clinical examination, blood work-up and imaging if required. If AA is confirmed, patients are given analgesia, intravenous fluids and IVAB (amoxicillin 2,000mg, metronidasole 500 mg and gentamicin 5 mg/kg), and are booked for an emergency appendicectomy. A laparoscopic appendicectomy is a preferred approach. Intraoperatively, the operating surgeon diagnoses CA, defined as a gangrenous or perforated appendix, determining postoperative antibiotic treatment for a minimum duration of five days. Postoperative IVAB can be changed to oral antibiotics (amoxicillin/clavulanic acid 875/125 mg) when after 48 h patients are responding well to therapy, which is determined by being afebrile and have a decreasing white cell count. Patients can then be discharged home. Antibiotics are ceased all together when patients are afebrile for 24 h with normalising white cell counts.
Related Knowledge Centers
- Abdomen
- Small Intestine
- Large Intestine
- Cecum
- Prenatal Development
- Vermiform
- Vestigiality
- Gut Microbiota
- Quadrants & Regions of Abdomen
- Iliac Fossa