Appendicitis

Question 1

how common is appendicitis?

what age group can it occur in?

Answer 1

• 10-15% of school children
• commonest cause of acute abdomen in childhood
• can occur at any age including young infants

Question 2

how does it present in older children?

Answer 2

• classical periumbilical pain moving down to the RIF

- low grade fever

Question 3

how does abdo pain present in babies/ young kids?

what examination must be done in all cases of suspected appendicitis?

Answer 3

• anorexia
• great reluctance to move
• vomiting in young child
• rectal examination

Question 4

what investigations would you do for appendicitis?

what is a complication of peritonitis?

where is the most common location of the appendix?

Answer 4

• FBC, U+Es
• bowel adhesions leading to volvulus
• retrocaecal and retrocolic

Question 5

what is mesenteric adenitis?

what does it usually result from?

Answer 5

• acute enlargement of the intra-abdominal lymph nodes causing pain which may be severe
• infection in the Upper/ lower respiratory tract or abdomen (gastroenteritis)

Question 6

what are the clinical features of mesenteric adenitis?

what features do you never get in mesenteric adenitis?

Answer 6

• recent history of infection
• signs may still be present in throat or chest.
• guarding and peritonism

Question 7

what is pyloric stenosis caused by?

when will it first present?and what sex is it most common in?

Answer 7

• hypertrophy and hyperplasia of the pylorus muscle
• first 4-6 weeks of life
• first born males

Question 8

what are the clinical features of pyloric stenosis?

what is the vomit like?

Answer 8

• projectile vomiting, during or after feeding
• infant is hungry and wanted another feed immediately
• weight loss
• dehydration
• blood tinged, NOT bile stained

Question 9

what will be found on examination of a pyloric stenosis patient?

do you need imaging for this case?

Answer 9

• hard mobile tumour (the pylorus) which feels like an olive/ acorn to the right of epigastrium, peristalsis
• once the tumour has been palpated there is no need for imaging

Question 10

what can happen in pyloric stenosis if baby is constantly vomiting?

Answer 10

• hypochloraemic alkalosis

- reduced serum sodium and potassium

Question 11

what is the management?

Answer 11

• surgical treatment
• Ramstedt procedure
• rehydration and replacement of ions

Question 12

what would be your differential diagnosis apart from pyloric stenosis?

Answer 12

• GOR
• possetting
• gastritis
• infection

Question 13

when can the child start feeding in after surgery?

Answer 13

• hours after

- excellent prognosis