Appendicitis

Question 1

Appendicitis definition

Answer 1

Acute inflammatory process involving the appendix

Question 2

How is a blockage caused in appendicitis?

Answer 2

Hard, mucousy stool or swelling due to a virus

Question 3

What does the blockage result in?

Answer 3

Appendix swells and becomes inflated –> possible rupture

Question 4

Appendicitis patho

Answer 4

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

Question 5

Complications from appendicitis

Answer 5

Abcess, perforation, sepsis, shock, wound infection

Question 6

Diagnostic criteria for appendicitis: PE

Answer 6

Low-grade fever, vomiting, radiating pain in the RLQ, decreased appetite, fever, constipation

Question 7

Diagnostic criteria for appendicitis: labs

Answer 7

Elevation of WBC, ANC, and/or CRP

Question 8

Diagnostic criteria for appendicitis: ultrasound

Answer 8

if non-diagnostic, CT scan or MRI needed for definitive assessment

Question 9

Diagnostic criteria for appendicitis: CT scan

Answer 9

Modality of choice for definitive assessment of patients

Question 10

Organisms involved in appendicitis

Answer 10

Bacteroides fragilis, E. coli, P. aeruginosa

Question 11

Appendicitis treatment: fluids

Answer 11

NS or LR at 1x maintenance

Sometimes maintenance rate at 1.5x or bolus if required

Question 12

Appendicitis treatment: analgesia for mild pain

Answer 12

APAP, ibuprofen

Question 13

Appendicitis treatment: analgesia for mod-severe pain

Answer 13

MORPHINE

Question 14

What controlled substances should you avoid using in pediatric patients for appendicitis and why?

Answer 14

Codeine and tramadol because of the 2D6 variance in kids

Question 15

What determines the ABX used in appendicitis treatment?

Answer 15

If the appendix bursts or not

Question 16

Appendicitis treatment for non-perforated appendix

Answer 16

Cefotetan, cefoxitin

Question 17

Cefotetan and cefoxitin cephalosporin generation

Answer 17

2nd

Question 18

2nd generation gram-positive coverage (in general)

Answer 18

Slightly weaker compared to 1st generation

Question 19

2nd generation gram-negative coverage

Answer 19

expands to HNPEK species

Question 20

Cefotetan and cefoxitin are cephamycins. What do they add in coverage?

Answer 20

Anaerobic activity (B. fragilis!!!)

Question 21

Appendicitis treatment for perforated appendix

Answer 21

Amp/sulbactam, pip/tazo

Question 22

Amp/sulbac and pip/tazo are _______ PCNs.

Answer 22

Extended spectrum

Question 23

Amp/sulbac, pip/tazo gram-positive coverage

Answer 23

Strep, enterococci, MSSA

Question 24

Amp/sulbac, pip/tazo gram-negative coverage

Answer 24

HNPEK, anaerobes

Question 25

Pip/tazo provides additional coverage against what?

Answer 25

Pseudomonas and CAPES organisms

Question 26

Criteria for ABX to be D/C’ed in appendicitis treatment

Answer 26

Afebrile, adequate PO intake/tolerating regular diet, ambulating, benign abdominal exam

Okay to discharge patient home on PO ABX!

Question 27

Minimum course treatment for IV ABX in appendicitis

Answer 27

5 days, some guidelines recommend 7-10

Question 28

Surgical approach to appendicitis

Answer 28

Laparoscopic > open appendectomy due to quicker recovery, shorter hospitalization, lower infection rate/risk