Appendicitis

Question 1

Describe the pathogenesis of appendicitis

Answer 1

Obstruction –> pressure –> venous congestion –> infection –> necrosis

Question 2

What are possible appendicitis obstructions?

Answer 2

Inflammation, Fecalith **, Calculi, Infection, Tumor

Question 3

Why is appendicitis a surgical emergency?

Answer 3

Untreated necrotic appendix may perforate and lead to sepsis within 3 days.

Question 4

What is the classical clinical presentation for Appendicitis

Answer 4

Early - vague, colicky periumbilical pain maybe w/ N/V and **Anorexia… low fever too

Later (w/in 12hrs) -Pain –> RLQ (mcburney)

*Pain is sharp and hurts with bumps and jumps… Pt will be still

Question 5

Different locations of pain may be due to what two causes?

Answer 5

Anatomical differences

Cecum migration during preg (Right flank and subcostal pain)

Question 6

How do we work up an appendicitis patient?

Answer 6

Labs - CBC, CMP, UA

Rads - CT (dont delay surg if ct not immed)

Question 7

How do we treat appendicitis?

Answer 7

Surgery…… Consult early

ABX maybe prior to surgery.

Cefs, Ampicillin-Sulbactam, Ertapenem