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
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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
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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
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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
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5
Q

Management of acute appendicitis

A
  • Iv fluids
  • surgery (laparoscopic or open)
  • Abx (ampicillin + gentamicin + metronidazole ) x24hr
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6
Q

Complications of acute appendicitis

A

Perforation ( >24 hr ↑ risk ), abscess, phlegmon
Surgical complications → spill bowel content, fistula, pelvic abscess

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