2 - Acute Appenditicits Flashcards

1
Q

MC patient type for appendicitis

A

Atraumatic acute abd pain without prior appendenctomy

Age 10 to 19 yrs

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2
Q

Appendicitis caused by:

A

Luminal obstruction of the vermiform appendix (typically a fecoltih)

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3
Q

McBurnery’s point

A

One third of the distance from the ASIS spine to the umbilicus

Right lower quadrant is MC spot for point tenderness / rebound tenderness

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4
Q

Early sxs appendicitis

A

General malaise
Indigestion
Bowel irregularity

Anorexia common

Periumbilical or central ABD pain generally develop after non-specific sxs

Possibly N/V

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5
Q

As it progresses, pain moves:

A

To the lower right quadrant

Flank pain, dysuria, hematuria can occur

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6
Q

What can help establish the dx?

A

Aggravating and alleviating features

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7
Q

If pain suddenly goes away, that’s good, right?

A

Nope! Could mean appendiceal rupture

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8
Q

Rebound tenderness and involuntary guarding suggests:

A

Peritonitis

(+) heel test

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9
Q

Rovsing’s Sign

A

Reproduces pain over McBurney’s point as the clinician palpates the descending colon in the LLQ

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10
Q

Psoas sign

A

Elicited if ABD pain is produced with extension of the right leg at the hip while pt lies on the left side

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11
Q

Obturator test

A

Pain with internal and external rotation of the flexed right thigh at the hip

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12
Q

If patient comes in with pain that looks like appendicitis and they’ve had pain there before,

A

Decreases likelihood that it’s appendicitis

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13
Q

Dx of appendicitis?

A

No H and P finding is sufficient to rule in or rule out appendicitis

May be happening but not clinically apparent

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14
Q

Consider appendicitis in any patient with:

A

Atraumatic right-sided abdominal, periumbilical, or flank pain who has their appendix

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15
Q

Slide 13

A

DDx for LRQ pain

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16
Q

Labs to order if you think appy?

17
Q

Lab testing overall?

A

Slide 15

Basically useless - nonspecific - good for finding other causes besides appendicitis

18
Q

Suspect appendicitis - call surgeon first or order imaging first?

A

Call the surgeon

19
Q

Goals of imaging

A

Establish the dx
Avoid a negative appendectomy
Identify perforation
Exclude other causes

20
Q

Plain films for appendicitis?

21
Q

Initial imaging modality of of choice in preggos and kids?

A

Graded compression US

22
Q

Typical US findings in appendicitis

A

Thickened, non-compressible appendix > 6mm

23
Q

Cut-off on US for appendix?

A

Less than 6mm = okay

Greater than 6mm = not okay

24
Q

Test for appendicitis?

A

Non-contrast CT - excellent performance in the dx of acute appendicitis

25
When to consider MRI
Preggos and kids Or If CT neg but strong suspicion
26
For the test
“Gold standard” = CT with contrast The right test to order for his test - noncontrast
27
As soon as you suspect appendicitis
NPO and consult Next, mIVF, antiemetics, analgesia
28
Standard of care for acute appendicitis?
Cut that fucker out
29
Acceptable regimen for ABX
KNOW ALL OF THIS Ampicillin/sulbactam 3gm IV (peds 75mg/kg IV) Pip-Tazo 4.5gm IV (peds 100mg/kg IV) Cefoxitin 2gm IV (peds dose 40mg/kg IV) Metronidazole 500mg PLUS ciprofloxacin 400mg IV
30
Stable pt?
Good pain control, can drink fluids, good to go home and come back within 12 hrs for re-eval
31
Laughter is the best medicine
Unless you had an appendectomy. Please dont do it, you may rip a stitch