2 - Acute Appenditicits Flashcards
MC patient type for appendicitis
Atraumatic acute abd pain without prior appendenctomy
Age 10 to 19 yrs
Appendicitis caused by:
Luminal obstruction of the vermiform appendix (typically a fecoltih)
McBurnery’s point
One third of the distance from the ASIS spine to the umbilicus
Right lower quadrant is MC spot for point tenderness / rebound tenderness
Early sxs appendicitis
General malaise
Indigestion
Bowel irregularity
Anorexia common
Periumbilical or central ABD pain generally develop after non-specific sxs
Possibly N/V
As it progresses, pain moves:
To the lower right quadrant
Flank pain, dysuria, hematuria can occur
What can help establish the dx?
Aggravating and alleviating features
If pain suddenly goes away, that’s good, right?
Nope! Could mean appendiceal rupture
Rebound tenderness and involuntary guarding suggests:
Peritonitis
(+) heel test
Rovsing’s Sign
Reproduces pain over McBurney’s point as the clinician palpates the descending colon in the LLQ
Psoas sign
Elicited if ABD pain is produced with extension of the right leg at the hip while pt lies on the left side
Obturator test
Pain with internal and external rotation of the flexed right thigh at the hip
If patient comes in with pain that looks like appendicitis and they’ve had pain there before,
Decreases likelihood that it’s appendicitis
Dx of appendicitis?
No H and P finding is sufficient to rule in or rule out appendicitis
May be happening but not clinically apparent
Consider appendicitis in any patient with:
Atraumatic right-sided abdominal, periumbilical, or flank pain who has their appendix
Slide 13
DDx for LRQ pain
Labs to order if you think appy?
WBC
Lab testing overall?
Slide 15
Basically useless - nonspecific - good for finding other causes besides appendicitis
Suspect appendicitis - call surgeon first or order imaging first?
Call the surgeon
Goals of imaging
Establish the dx
Avoid a negative appendectomy
Identify perforation
Exclude other causes
Plain films for appendicitis?
Useless
Initial imaging modality of of choice in preggos and kids?
Graded compression US
Typical US findings in appendicitis
Thickened, non-compressible appendix > 6mm
Cut-off on US for appendix?
Less than 6mm = okay
Greater than 6mm = not okay
Test for appendicitis?
Non-contrast CT - excellent performance in the dx of acute appendicitis
When to consider MRI
Preggos and kids
Or
If CT neg but strong suspicion
For the test
“Gold standard” = CT with contrast
The right test to order for his test - noncontrast
As soon as you suspect appendicitis
NPO and consult
Next, mIVF, antiemetics, analgesia
Standard of care for acute appendicitis?
Cut that fucker out
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
Stable pt?
Good pain control, can drink fluids, good to go home and come back within 12 hrs for re-eval
Laughter is the best medicine
Unless you had an appendectomy. Please dont do it, you may rip a stitch
