Appendicitis Flashcards
1
Q
Signs and symptoms of acute appendicitis
A
- Fever (low grade unless perforation )
- migratory abdominal pain: peri umbilical → mcburney’s. Constant, dull
- rigidity
- anorexia / nausea/vomiting
2
Q
Atypical locations of appendix and associated signs
A
- Inferior appendix → mcburneys, rovsig’s (palpation of llq causes mcburney’s pain)
- retrocecal appendix → psoas sign (flexion of hip against resistance, passive hyper extension of hip )
- pelvic appendix → obturator sign (flexion then external or internal rotation of R. Hip elicits pain
3
Q
Investigations to confirm acute appendicitis
A
- ↑ WBC with left shift
- beta HCG in females of reproductive age
- u/s abdomen
- ct abdomen → thick wall, appendicolith (after u/s)
- air → air under diaphragm if perforated close of psoas shadow
4
Q
What clinical score is used for children presenting to Er with sx suggestive of appendicitis
A
PALabS scare for children 2-14, score less than or equal to 6 → appendicitis unlikely.
- crp > 10 mg/l →2
- nausea →3
- calprotectin > 0.5 ng/ml →3
- focal RLQ pain → 4
- WBC > 10 x → 4
- ANC (neutrophils) > 7500 →7
5
Q
Management of acute appendicitis
A
- Iv fluids
- surgery (laparoscopic or open)
- Abx (ampicillin + gentamicin + metronidazole ) x24hr
6
Q
Complications of acute appendicitis
A
Perforation ( >24 hr ↑ risk ), abscess, phlegmon
Surgical complications → spill bowel content, fistula, pelvic abscess