appendicitis

Question 1

appendicitis

Answer 1

most common abdominal surgical emergency
10% population ages 1- 30 years old
elderly 14% of cases have a 50% death rate

appendix obstruction causes
fecal inflammation, foreign body, or neoplasm
obstruction, increase intraluminal pressure , venous congestion infection and thrombosis

risk for gangreen and peforation
if not treated in 24-36 hours

Question 2

clinical findings appendicitis

Answer 2

cholicky peruimbicial pain or epigastric pain
right lower q pain
low-grade fever

high grade or rigors; ruputre

peritoneal irritation
the cough produced the pain

Psoas sign:
Pain or passive extension of right hip

obturator sign
pain with passive flexion, an internal rotation of right hip

leukcoctosis
10-20000
neurtopheiliea

microscopic hematruia and puria
present in 25% of the patients

Question 3

appendicitis diagnosis and treatment

Answer 3

abdominal US and CT
CT high sensititvy and specificity

eary uncomplicated:
surgical appendectomy
perferably laposcopy
abx:
covers before surgery
single dose
gram neg and anarobic coverage

Conservative approach:
antibiotics
20-30% reoccurrence of appendicitis

perforated appendicitis :
emergent appy
perforation with contained abscess:
CT guided drain
IV abx
appendectomy 6 weeks later