Appendicitis Flashcards
Acute appendicitis is most common in patients age
10 to 19 years
most frequent cause of atraumatic abdominal pain in children >1 year old
Acute appendicitis
most common nonobstetric surgical emergency in pregnancy, complicating up to 1 in 1500 pregnancies
Acute appendicitis
True or false
consider appendicitis in any patient with acute atraumatic abdominal pain without prior appendectomy
True
McBurney’s point is located where?
one third of the distance from the anterior superior iliac spine to the umbilicus.
How many percent of patients may have an atypical presentation due in part to anatomic variation
50%
retrocecal appendix produces___________pain whereas malrotation of the colon results in transposition of the appendix and, subsequently, pain to the_____________
right flank or pelvic pain
left upper quadrant
location of pain remains the most common location of pain in pregnant women with appendicitis
Right lower quadrant
worsening pain with deep inspiration may be present if there is
peritoneal irritation
exception to right lower quadrant pain is ____________, which does not contact the anterior parietal peritoneum.
retrocecal appendix
Rovsing’s sign
reproduces pain over McBurney’s point as the clinician palpates the descending colon in the left lower quadrant
psoas sign is elicited if
abdominal pain is produced with passive extension of the right leg at the hip while the patient lies on the left side
obturator test elicits
pain with passive internal and external rotation of the flexed right thigh at the hip
True or false
In both children and adults, however, no single historical or physical examination finding is sufficient to rule in or rule out appendicitis. Their utility is increased in combination
True
True or false
 Acute appendicitis is largely a clinical diagnosis, and no one adjunctive test is universally indicated
 True
True or false
 Consider appendicitis in any patient with atraumatic right-sided abdominal, periumbilical, or flank pain who has not previously undergone appendectomy
True
Modified Alvarado score for acute appendicitis
Symptoms
migration, 1 point
anorexia or urinary acetone, 1 point
nausea or vomiting, 1 point
signs
right lower quadrant tenderness, 2 points
rebound, 1 point
fever, 1 point
WBC count (>10,000/mm3, 2 points)
low-risk appendicitis (score, 1 to 4)
possible or probable appendicitis (score, 5 to 9).
should be the initial imaging modality of choice in both pregnant females and children. It should likewise be considered in young, nonobese adults
Graded compression US
Typical US findings in appendicitis are a thickened, noncompressible appendix______ in diameter
> 6 mm
US Perforation
may lead to disappearance of specific imaging hallmarks and difficult visualization of the appendix on US.
In most adult males and nonpregnant females for whom the diagnosis of appendicitis is not sufficiently clear, consider which imaging
abdominal CT that includes the abdomen and pelvis
stable, reliable patient without significant comorbidities may be a candidate for discharge provided they have a scheduled return visit to the ED or their primary physician (typically within _____hours) for repeat examination
12 hours
