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home - Colon - Miscellaneous - Appendix Cancer 2 Written by Dr Sebastian Zeki
Methods GMP
Knows the physiology of intestinal absorption, secretion and motility SCE 1
Understands the biochemical processes occurring within the gut
lumen and at mucosal level

Has awareness of the factors controlling these processes – in
particular the neuro-endocrine influences

Understands the range of mechanisms by which diarrhoea can result
from disturbances in each of these processes

Knows the causes of both acute and chronic diarrhoea
Knows the range of investigations appropriate to determining the
cause of the patient’s diarrhoea and is aware of the range of
therapeutic possibilities

Makes a detailed clinical assessment of patients that present with
either acute or chronic diarrhoea

Recognises the potential need for urgent fluid replacement CbD,
Makes appropriate use of microbiology and other relevant laboratories in reaching a diagnosis

Shows ability to interpret results, reach a diagnosis and formulate a
treatment plan

Reacts appropriately to the urgency of the clinical presentation
Always shows sympathy and understanding especially when the
patient is distressed

Appendix Cancer 2

Diseases of the appendix Demographics The peak age of onset if 15-19. The M:F ratio is 1.4:1. The lifetime incidence is 8%. Mimickers: Mesenteric lymphadenitis.Gastroenteritis. AnatomyThe appendix can be in the retrocecal (65 %) or pelvic (30 %) positions.The appendix can be up to to 10 cm in length with a diameter up to 1.0 cm Lab Results:Microscopic hematuria and pyuria in 1/3rd.Normal WCC in 30%. Clin Pres: Radiographic Tests TreatmentGeneral measures:Supportive; Postoperative antibiotics unnecessary. Ileocolic artery Appendiceal artery Blood supply Nonspecific sense of not feeling well. Then get poorly localizable central abdominal discomfort Localises to RIFCan get pain on rectal and pelvic exam unless retro-caecal appendixPelvic apendix complain of urinary frequency and dysuria/rectal symptoms (tenesmus and diarrhea) N&V follow pain not beforeSubsequent low grade fever and mild leuko-cytosis. Signs: -Rosvigs sign- RIF pain with LIF palpation. Valentinos sign. McBurney's point. Ileopsoas- Pain in the RLQ brought on by extension of the right hip -assoc.with retrocecal appendix. Obturator sign -Pain on internal hip rotation assoc.with a pelvic appen - dix. Lymphoid follicular hyperplasia initiated by viral or bacterial infection and subse-quent dehydration Fibrosis, fecaliths, or neoplasia Fills with fluid -Lumen distends, increasing luminal and intramural pressure resulting in thrombo-sis and occlusion of the small vessels, and stasis of lymphatic flow.-Wall of the appendix becomes ischemic and then necrotic.-Bacterial overgrowth occurs within the diseased appendix. Necrosis with perforation and subsequent local-ized abscess/ or diffuse peritonitis. Death 3% PV suppurative thrombosis Perforation The highest risk is in kids and the elderly/ DM/ immu-nosuppressed.Suspect a perforation if temp > 38degC / WCC> 15). 0.1% Young Patients Older Patients Pathology USS:Sen 94% and spec 95%.CT 1.Standard CT scanA thick walled appendix (>2 mm);Appendicolith (25%);Target structure (concentric thick-ening of the inflamed appendiceal wall);Phlegmon;Abscess;Free fluid;Fat stranding/right lower quadrant inflammation;Air in the appendix or a contrast filled lumen in a normal appearing appendix virtually excludes the diagnosis.Nonvisualized appendix doesn’t rule out appendicitis (normal appendix not seen in 25%)Appendiceal CT scan (rectal contrast alone +thin cuts through the RIF). Written by Dr Sebastian Zeki Late presentation24-72 hrs after symptom onset usually undergo immediate appendectomy.If >72 hours with RIF pain, treat conservatively as may have a localised abscess that can be drained percu-taneously with appendec-tomy 8-10 weeks later.Older patients should have a colonoscopy or barium enema to rule out cecal pathology.If no appendectomy, need a follow-up CTOperative approachLaporoscopic vs openLess pain, shorter hospital stay, earlier return to work after laparoscopicBUT.....More expensive and longer procedureComplications of opera-tionWound infection/ intrab-dominal abscess (usually if have perforation-very rare in those with simple appen-dicitis).Pylephlebitis