Colon And Rectum: Appendicitis

The patient's presentation of periumbilical pain that migrates to the right lower quadrant, along with exacerbation of pain with movement and associated symptoms of nausea, vomiting, and low-grade fever, are all classic signs of acute appendicitis. Acute appendicitis occurs when the appendix becomes inflamed and infected, leading to these characteristic symptoms. The other options, such as ovarian cyst, volvulus, acute pancreatitis, and acute cholecystitis, do not typically present with this specific combination of symptoms.

The correct answer is surgical removal of inflamed appendix before it ruptures. Appendicitis is the inflammation of the appendix, and if left untreated, it can lead to a rupture, causing a life-threatening condition. The most effective treatment for appendicitis is the surgical removal of the inflamed appendix, known as an appendectomy. This procedure is typically performed before the appendix ruptures to prevent complications and ensure a faster recovery. Pain control and antibiotics may be used as part of the treatment plan, but the primary intervention is the surgical removal of the inflamed appendix.

The portal vein carries venous blood from the intestines to the liver. This vein is responsible for transporting nutrient-rich blood from the digestive system to the liver, where it is processed and detoxified before entering the systemic circulation. The other options listed are not involved in this specific function of carrying blood from the intestines to the liver.

A MANTRELS score is a scoring system used to assess the likelihood of appendicitis. A score of over 8 indicates a higher probability of appendicitis. Therefore, the correct answer "very probable appendicitis" suggests that a MANTRELS score of over 8 strongly indicates the presence of appendicitis.

The anal canal is a part of the digestive system that is approximately 3-4 cm long. It begins at the dentate line and is supported by the internal and external anal sphincters. The anal canal is composed of sensitive squamous epithelium.

The rectum extends from the rectosigmoid junction to the anal canal and is composed of insensitive columnar epithelium. This means that it is the correct answer to the question. The anal canal, colon, and large bowel are not the correct answers because they do not fit the description given in the question.

The superior mesenteric artery supplies blood to the small intestine (other than duodenum) and proximal colon. This artery is a major branch of the abdominal aorta and provides oxygenated blood to these specific regions of the gastrointestinal tract. The duodenum, cecum, and rectum are supplied by different arteries.

Appendicitis is primarily caused by the obstruction of the lumen between the cecum and appendix. When the opening of the appendix gets blocked, it can lead to the buildup of mucus, bacteria, and stool, resulting in inflammation and infection. This obstruction can occur due to various factors such as fecal matter, enlarged lymphoid tissue, or tumors. Inflammation due to an immune response, constipation, and overuse of antibiotics are not the primary causes of appendicitis.

The blind sac that is in the RLQ below the ileocecal valve is called the cecum. The cecum is a pouch-like structure that is the first part of the large intestine. It is located in the lower right quadrant of the abdomen and serves as a site for the absorption of water and electrolytes. The appendix is a small, finger-like projection that extends from the cecum. The transverse colon is a part of the large intestine that runs horizontally across the abdomen, while the ascending colon is the part of the large intestine that travels upward on the right side of the abdomen.

The correct answer is celiac artery, superior mesenteric artery, inferior mesenteric artery. These three major branches of the aorta supply blood to the intestines. The celiac artery supplies blood to the upper abdominal organs, including the stomach and liver. The superior mesenteric artery supplies blood to the small intestine and the first half of the large intestine. The inferior mesenteric artery supplies blood to the second half of the large intestine.

The possible causes of an obstructed appendix include inflammatory bowel disease, infection, fecal stasis, calcium salts or undigested fiber- fecaliths, parasites, foreign bodies (fb), and neoplasms. These factors can lead to blockage or inflammation of the appendix, resulting in appendicitis.

The correct answer suggests that while examining a patient with suspected appendicitis, one would expect to find pain with guarding, rebound tenderness, and passive flexion of the right hip. However, there would not be pain with passive flexion of the left hip. Additionally, a positive obturator sign would be present.

A MANTRELS score is a scoring system used to assess the likelihood of appendicitis. A score of less than five indicates that the likelihood of appendicitis is low. Therefore, the correct answer is "appendicitis is less likely."

The celiac artery supplies blood to the duodenum, which is the first part of the small intestine. This artery is a major branch of the abdominal aorta and provides oxygenated blood to various organs in the abdominal region, including the stomach, liver, spleen, and parts of the small intestine.

The superior rectal artery supplies blood to the upper and middle rectum. This artery is a branch of the inferior mesenteric artery and plays a crucial role in providing oxygenated blood to this part of the gastrointestinal tract.

The correct answer is superior rectal artery, middle rectal artery, and inferior rectal artery. These three arteries supply the anorectum. The superior rectal artery is a branch of the inferior mesenteric artery, while the middle rectal artery is a branch of the internal iliac artery. The inferior rectal artery is a branch of the internal pudendal artery, which itself is a branch of the internal iliac artery.

During the rectoanal inhibitory reflex, the internal sphincter relaxes, allowing the contents into the anal canal. Then, the external sphincter contracts, pushing the contents back into the rectum. This reflex occurs multiple times daily, up to 7 times.

The correct answer is mid-transverse colon to rectum. The inferior mesenteric artery is responsible for supplying blood to the mid-transverse colon, descending colon, sigmoid colon, and rectum. It does not supply blood to the cecum or the anal canal.

A MANTRELS score of 5-6 indicates possible appendicitis. This means that based on the MANTRELS scoring system, which evaluates various symptoms and signs associated with appendicitis, a score of 5-6 suggests that there is a possibility of the patient having appendicitis. However, further diagnostic tests and evaluations are required to confirm the diagnosis.

A MANTRELS score of 7-8 indicates probable appendicitis. This means that based on the scoring system used, the patient's symptoms and clinical findings suggest a high likelihood of appendicitis. The score falls within the range that is typically associated with a high probability of the condition.

The appendix is made up of lymphatic tissue. The lymphatic tissue is a part of the immune system and helps in the production of white blood cells and antibodies. The appendix contains lymphoid follicles, which are clusters of lymphatic tissue that play a role in immune responses. This makes the lymphatic tissue the correct answer for the type of tissue that makes up the appendix.

The inferior rectal artery supplies blood to the internal and external anal sphincters. These sphincters are located at the opening of the anus and are responsible for controlling the passage of stool. The blood supply is important for maintaining the health and function of these muscles.

When the appendix is obstructed, the inflamed tissue inside it becomes infected and starts to die due to a lack of blood supply. As the infection progresses, the pressure builds up inside the appendix, eventually causing it to burst. This can lead to the release of the infected contents into the abdominal cavity, resulting in a serious condition called peritonitis.

A left shift in the MANTRELS score refers to the presence of bands (immature neutrophils) in the blood that make up over 75% of the total neutrophil count. This indicates an increase in the number of immature neutrophils, which can be a sign of an infection or inflammation in the body.

In the given question, the correct answer is 10%. This means that approximately 10% of people will experience appendicitis at some point in their lifetime. Appendicitis is a condition characterized by inflammation of the appendix, a small organ located in the lower right abdomen. It is a relatively common condition that often requires surgical removal of the appendix. By stating that 10% of people will have appendicitis, it suggests that this condition is not extremely rare, but also not overly prevalent in the general population.

The middle rectal artery supplies blood to the lower rectum.

The contraction of propulsive waves that move stool distally from the cecum is stimulated by the distention of the colonic wall. When the colonic wall becomes distended, it triggers the muscular contractions necessary for propelling stool through the colon and towards the rectum. This distention acts as a signal for the muscles in the colon to contract and move the stool along the digestive tract.

The mid-transverse colon is responsible for propelling retrograde waves of contraction to allow the cecum to retain liquid feces and act as a 'fermenting vat'.

The diagnostic features of acute appendicitis include low-grade fever less than 100.4F/38C, moderate leukocytosis (10,000-20,000), ultrasound, and CT (with contrast depending on body habitus). CT is also helpful if perforation is suspected to diagnose periappendiceal abscess. These features can help in the diagnosis of acute appendicitis.

During defecation, the movement of feces into the rectum triggers the voluntary relaxation of the pelvic floor and external sphincter mechanism. This allows for the passage of feces through the anus. Additionally, there is a voluntary increase in intra-abdominal pressure, which helps to push the feces out of the rectum and through the anal canal. These two mechanisms work together to facilitate the process of defecation.

The four positive findings on a physical exam of someone with acute appendicitis are RLQ pain with guarding, rebound tenderness, psoas sign, and obturator sign. RLQ pain with guarding refers to pain in the right lower quadrant of the abdomen that worsens with pressure and is accompanied by muscle tension. Rebound tenderness is when there is pain upon releasing pressure from the abdomen. The psoas sign is positive when flexing the hip against resistance causes pain in the RLQ. The obturator sign is positive when internal rotation of the hip causes pain in the RLQ. These findings help in diagnosing acute appendicitis.

In the MANTRELS scoring method, RLQ tenderness and shift left are worth 2 points each as symptoms. RLQ tenderness refers to tenderness or pain in the right lower quadrant of the abdomen, which may indicate inflammation or infection in the appendix. Shift left refers to the presence of abnormal white blood cells in a blood test, indicating an infection or inflammation in the body. These two symptoms are given a higher point value because they are commonly associated with appendicitis, a condition that requires immediate medical attention.