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Exemplar Appendicitis Exam Questions with Correct Answers
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Exemplar Appendicitis Exam Questions with Correct Answers
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Exemplar Appendicitis Exam Questionswith Correct Answers
Appendicitis - Answer-Inflammation of the vermiform appendix, is a common cause of
acute abdominal pain. Many cases it involves emergency surgery. More common in
adolescents and young adults.
Pathophysiology: - Answer--Appendix is a tubelike pouch attached to the cecum just
below the ileocecal valve. Located in the right iliac region in an area called McBurney
point.
-Obstruction of the proximal lumen of the appendix is apparent in most acutely inflamed
appendices. Following obstruction appendix becomes distended with fluid secreted by
its mucosa. Pressure within the lumen of the appendix increases, impairs its blood
supply, and leads to inflammation, edema, ulceration, and infection.
Cont... - Answer--The purulent exudate causes further distention of the appendix, if
treatment not initiated tissue necrosis and gangrene result within 24-36 hours leading to
perforation (rupture). This allows the GI contents to flow into the peritoneal space of the
abdomen resulting in peritonitis (inflammation & bacterial infection of the entire
abdominal area).
-Appendicitis is classified as simple, gangrene, or perforated.
Simple Appendicitis: - Answer-Appendix inflamed but intact.
Gangrenous Appendicitis: - Answer-Areas of tissue necrosis and microscopic
perforations are present.
Perforated Appendicitis: - Answer-Gross perforation and contamination of the peritoneal
cavity.
Etiology: - Answer-Almost always caused by an obstruction in the appendiceal lumen,
this obstruction often caused by a hard mass of feces. Other obstructive causes are
calculus, parasites, edema of lymphoid tissue, tumor, or a foreign body. Continued
secretion of mucus following obstruction increases pressure causing ischemia,
inflammation, cellular death, and ulceration.
Risk Factors: - Answer-Adolescent males at greatest risk! Individuals diet whose low in
fiber or high in carbs can develop feces masses.
Prevention: - Answer-Eat foods high in fiber such as fresh fruits and veggies. Staying
hydrated!
, Clinical Manifestations: - Answer--Initial symptoms are continuous, mild, generalized or
upper abdominal pain.
-Over next four hours pain intensifies and localizes in the right lower quadrant.
-Pain is aggravated by moving, walking, or coughing. On palpation, localized and
rebound tenderness are noted at McBurneys point. [Rebound tenderness is a relief of
pain with direct palpation, followed by pain on release of pressure]
-Extension or internal rotation of right hip increases pain.
-Low grade fever, anorexia, nausea, vomiting.
cont... - Answer--Older adults don't show acute pain or local tenderness so the
diagnosis is delayed making the course of acute appendicitis more virulent increasing
the mortality rate.
-Pregnant women may get right lower quadrant pain, periumbilical, or right subcostal
(under rib) pain due to displacement of appendix.
-Perforation is manifested by increased pain & a high fever.
-Chronic appendicitis characterized by chronic abdominal pain and recurrent acute
attacks at intervals of several months or more.
Peritonitis resulting from appendix rupture with bowel contents leaking into the
abdominal cavity: - Answer-*High fever, acute severe abdominal pain, abdominal
distention, can result in death.
*Removal of the appendix, antibiotics, fluid restoration, maintain VS.
Chronic Appendicitis: - Answer-*Chronic recurrent abdominal pain over several months.
*appendectomy, pain management.
Lifespan & Cultural Considerations: - Answer--Uncommon for children age 4 and under
to have appendicitis, but when they do it progresses to rupture because they can't tell
parents how they feel. Common symptoms would be listlessness, inconsolability,
vomiting, distended abdomen. Its low on the diagnostic priority for kids so the delay in
diagnosis and an increase in rupture, complications, and death in infant population.
-Older adults are likely to present with confusion.
Collaboration: - Answer-Acutely inflamed appendix can perforate within 24 hours, so
rapid diagnosis and treatment are important. Client admitted to the hospital and
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