42. APPENDICITIS

Question 1

Definition of Appendicitis

Answer 1

APPENDICITIS is defined as the inflammation of the vermiform appendix which ranges from a simple, congestive form —> a more complicated transmural involvement eventually leading to perforation.

M/c abdominal surgical emergency
Lifetime risk 9% in males, 7% in females

Question 2

Murphy’s triad of Appendicitis

Answer 2

Pain —> Vomiting —> Fever
*Pain ang first symptom

*If nauna ang GI sypmtoms before pain = GASTROENTERITIS

Question 3

What does it imply if

Nausea Vomiting comes before PAIN and FEVER????

Answer 3

GASTROENTERITIS

Question 4

Why does pain worsen on deep inspiration?

Answer 4

peritoneal inflammation

(+) abdominal guarding

(+) Blumberg’s sign/Rebound tenderness, also referred to as rebound tenderness, refers to palpation and quick release, with pain felt upon release of pressure - again a sign of peritoneal irritation.

Question 5

Paano if may resolution of pain na sa acute appendicitis?

Answer 5

This is not a good sign because this might mean perforation, and with perforation comes the release of intraluminal obstruction. That’s why there’s sudden improvement of pain.

Question 6

How to diagnose appendicitis

Answer 6

Symptoms:

M igration of pain A norexia N ause vomiting

Signs:

T enderness in the RLQ - 2 pts
R ebound tenderness
E levated temperature

Labs:

L eukocytosis >10,000 - 2 pts
S hift of WBC count to the left

A score of less than 5 –> appendicitis UNLIKELY
5-6 –> POSSIBLE
7-8 –> appendicitis LIKELY
9-10 –> HIGHLY LIKELY

Question 7

Diagnostics of Acute Appendicitis

Answer 7

CBC, Urinalysis, PT (R/o PREGNANCY)
UTZ: initial imaging modality of choice, non-invasive no contrast medium required

(+) THICKENED, NON-COMPRESSIBLE APPENDIXES with >6 mm DIAMETER

Question 8

Acute Appendicitis

Perioperative antibiotics

Answer 8

Initiate perioperative antibiotics upon diagnosis or if patient exhibits signs of peritonitis (broad-spectrum with aerobic and anaerobic gram-negative coverage)

Cefoxitin 2 g IV (pediatric dose: 40 mg/kg)

Ampicillin-sulbactam 3 g IV (pediatric dose: 75 mg/kg IV)

Metronidazole 500 mg IV + ciprofloxacin 400 mg IV

Piperacillin-tazobactam 4.5 g IV (pediatric dose: 100 mg/kg IV)

Question 9

Tx difference between uncomplicated vs perforated appendicitis

Answer 9

Open appendectomy with MCBURNEY/ROCKY DAVIS INCISION (early non-perforate appendicitis)

Lower Midline Laparotomy (Perforated)

Laparoscopic - less invasive, shorter hospital stay