57. Acute appendicitis in pediatrics, during pregnancy and in old patients

Question 1

Acute appendicitis in young - Diagnosis

Answer 1

Much more difficult as Children unable to give an accurate history of symptoms

Question 2

Acute appendicitis in young - Key facts

Answer 2

GI problems in kids leads to misdiagnosis

• Genetically symptoms include = RLQ tenderness, unable to walk.
• Pain on percussion (Razdolsky sign) or coughing (Dunphy’s sign)
• Morbidity is > due to – rapid progression to rupture
• Underdeveloped omentum to contain rupture

Question 3

Acute appendicitis in elderly - Diagnosis

Answer 3

Diagnosis is difficult due to atypical presentation

• Lower ab pain that isn’t localised to RLQ
• Increased risk of perforation + as they have other co-morbidities
  o Admitted for longer

Question 4

Acute appendicitis in pregnancy - Diagnosis

Answer 4

Difficult diagnosis as abdominal symptoms are considered preg related

Question 5

Acute appendicitis in pregnancy - key points

Answer 5

Most common surgical procedure during preg

Occur at any time during preg – more common 1st + 2nd trimester

Question 6

Anatomical changes to appendix in pregnancy

Answer 6

Appendix is displaced by uterus

o Displaced to RUQ

o Atypical presentation = pain on right side – heart burn feeling

o N/V difficult to relate to appendicitis

Question 7

Acute appendicitis in pregnancy - Diagnostic investigations

Answer 7

Use ab US
MRI
CT