Appendicitis

Question 1

Acute appendicitis - background

Answer 1

1. Def = acute inflammation of vermiform appendix
2. Epi = may occur at any age, but rare under 5y. Commonest abdominal emergency in children, affecting 1/6 of the population
3. . Begins with obstruction of lumen of appendix, often by fecolith ( -> vague central abdominal pain)
4. After 6-12hrs, an inflammatory process involves the full thickness of the wall of the appendix
5. After a further 24-36hrs, the appendix will become gangrenous and perforate

Question 2

Acute appendicitis - symptoms (3)

Answer 2

1. Anorexia
2. Vomiting (usually only a few times)
3. Abdominal pain, initially central and colicky (appendicular midgut colic) but then localising to the R iliac fossa (from localised peritoneal inflammation)

Question 3

Acute appendicitis - signs

Answer 3

1. Flushed face with oral fetor
2. Low grade fever
3. Abdominal pain aggravated by movement (e.g. walking, coughing, bumps on the road during a car journey)
4. Persistent tenderness with guarding in the RIF (McBurney’s point)
5. Guarding = involuntary spasm in the muscles of the abdominal wall due to peritoneal irritation

Question 4

Acute appendicitis - ix/dx (3)

Answer 4

**Dx made clinically

Other ix:

1. U/S - if dx uncertain but child likely to have appendicitis
2. Urinalysis (note - abnormal in 1/3 of children with acute appendicitis; avoid starting abx for presumptive dx of UTI unless there are symptoms of dysuria)
3. Lab studies rarely helpful, but can perform FBE (typically raised WCC)

Question 5

Acute appendicitis - mx

Answer 5

1. Appendectomy with laparoscopic approach, plus:
2. Preoperative preparation - adequate hydration with IV crystalloids + correction of electrolyte abnormalities
3. Urethral catheter if child severely dehydrated, NGT if child has persistent vomiting
4. Analgesia (IV opioids), abx = gentamicin + amoxycillin + metronidazole IV
5. Oral fluids can be introduced as soon as child is awake. Solid food as tolerated. Discharge within 24-48hrs