appendicitis

Question 1

6 y.o. boy brought to casualty with 4 hour hx of abdo pain and feeling hot. has pain in RIF w rebound tenderness.

(a) what are your 3 ddx and what is the most likely dx?

Answer 1

1. acute appendicitis
2. gastroenteritis
3. mesenteric adenitis
4. Meckel’s diverticulitis

Question 2

(b) give 2 features which, on further questioning, would support this dx?

Answer 2

• migration of pain from central abdomen to become localised in RIF
• anorexia

Question 3

(c) give 2 features on examination that would support this dx

Answer 3

• Rovsing’s sign - greater pain felt in RIF on palpation of LIF
• tenderness over McBurney’s point

Question 4

(d) the child suddenly develops widespread severe abdominal pain and becomes shocked. BP is now 70/40, what is the most likely cause of such a development?

Answer 4

perforated appendix causing peritonism

Question 5

(e) give 2 findings on examination which would support this dx?

Answer 5

• air under diaphragm on erect CXR
• rigid, board-like abdomen on palpation

Question 6

(f) give 2 therapeutic measures which might subsequently be performed in this child

Answer 6

• IV abx
• urgent laparotomy