Appendicitis Flashcards
Appendicitis definition
Acute inflammatory process involving the appendix
How is a blockage caused in appendicitis?
Hard, mucousy stool or swelling due to a virus
What does the blockage result in?
Appendix swells and becomes inflated –> possible rupture
Appendicitis patho
Luminal obstruction can cause an increase in pressure within the lumen
Appendix continues to secrete mucosal fluid, leading to distention
Ischemia, bacterial overgrowth, and eventual perforation follow suit
Complications from appendicitis
Abcess, perforation, sepsis, shock, wound infection
Diagnostic criteria for appendicitis: PE
Low-grade fever, vomiting, radiating pain in the RLQ, decreased appetite, fever, constipation
Diagnostic criteria for appendicitis: labs
Elevation of WBC, ANC, and/or CRP
Diagnostic criteria for appendicitis: ultrasound
if non-diagnostic, CT scan or MRI needed for definitive assessment
Diagnostic criteria for appendicitis: CT scan
Modality of choice for definitive assessment of patients
Organisms involved in appendicitis
Bacteroides fragilis, E. coli, P. aeruginosa
Appendicitis treatment: fluids
NS or LR at 1x maintenance
Sometimes maintenance rate at 1.5x or bolus if required
Appendicitis treatment: analgesia for mild pain
APAP, ibuprofen
Appendicitis treatment: analgesia for mod-severe pain
MORPHINE
What controlled substances should you avoid using in pediatric patients for appendicitis and why?
Codeine and tramadol because of the 2D6 variance in kids
What determines the ABX used in appendicitis treatment?
If the appendix bursts or not
Appendicitis treatment for non-perforated appendix
Cefotetan, cefoxitin
Cefotetan and cefoxitin cephalosporin generation
2nd
2nd generation gram-positive coverage (in general)
Slightly weaker compared to 1st generation
2nd generation gram-negative coverage
expands to HNPEK species
Cefotetan and cefoxitin are cephamycins. What do they add in coverage?
Anaerobic activity (B. fragilis!!!)
Appendicitis treatment for perforated appendix
Amp/sulbactam, pip/tazo
Amp/sulbac and pip/tazo are _______ PCNs.
Extended spectrum
Amp/sulbac, pip/tazo gram-positive coverage
Strep, enterococci, MSSA
Amp/sulbac, pip/tazo gram-negative coverage
HNPEK, anaerobes
Pip/tazo provides additional coverage against what?
Pseudomonas and CAPES organisms
Criteria for ABX to be D/C’ed in appendicitis treatment
Afebrile, adequate PO intake/tolerating regular diet, ambulating, benign abdominal exam
Okay to discharge patient home on PO ABX!
Minimum course treatment for IV ABX in appendicitis
5 days, some guidelines recommend 7-10
Surgical approach to appendicitis
Laparoscopic > open appendectomy due to quicker recovery, shorter hospitalization, lower infection rate/risk
