Acute Abdomen and Appendicitis

Question 1

What additional questions, examinations and tests should be done in a patient with acute abdomen?

Answer 1

Girls:
Gynae history
Preganancy test for pubertal girls

Boys:
Testicular examination pain can often be referred to the abdomen

Question 2

Outline the acute management of an acute abdomen patient in shock?

Answer 2

Oxygen - high flow 100%
IV antibiotics - sepsis
IV fluids - consider loss 20ml/kg isotonic fluid over 5 mins

Bloods - FBC, U&Es, CRP, LFTs, glucose 
Urine output (good marker)
Blood cultures (if infection is suspected)

Consider NG tube.

Nil by mouth if likely surgical.

ESCALATE

Question 3

What is the most common surgery performed in the acute abdomen setting?

Answer 3

Appendectomy

Question 4

What is the classical presentation of appendicitis?

Answer 4

Umbilical pain which moves to the RIF after 1/2 days.
Systemic illness.
Peritonitic pain (worse on movement, very tender, percussion/rebound tenderness) - Rovsing sign, obturator sign, guarding

May be vomiting or have diarrhoea.

Urine dip could be abnormal may be a red herring, if there is RIF pain still consider appendicitis.

Question 5

What is the presentation of appendicitis, when the appendix is in the right iliac fossa?

Answer 5

Appendix in the right iliac fossa, posterior to bowel:
Vague deep tenderness may have guarding
May develop appendicular mass or perforation (sepsis).
Posterior peritoneum/psoas may be inflamed, patient may limp to alleviate pain. Appendix shuffle.

Question 6

What is the presentation of appendicitis when the appendix is in the pelvis?

Answer 6

Vague suprapubic tenderness, with no guarding.
Per rectum exam may illicit tenderness or a mass.
Possible to have urinary/bowel symptoms due to irritation of these structures.
Likely to perforate

Question 7

What is an appendicular mass?

Answer 7

An appendicular mass is when the appendix comes inflamed and becomes covered in the omentum.

Question 8

What is the management of appendicitis?

Answer 8

IV fluids
IV antibiotics
Appendectomy

If there is an appendicular mass treat with targeted antibiotics until the patient has improved and the patient can have a non emergency appendectomy.

Question 9

What are the common causes of acute abdomen in children?

Answer 9

Gastroenteritis
Constipation
Mesenteric adenitis
UTI 
Appendicitis

Question 10

What are 2 very important but less common conditions to be aware of in children with acute abdomen?

Answer 10

Billious vomiting in any child is malrotation volvulus unless proven otherwise.

Interssusception