Appendicitis_Flashcards
What is the management for suspected appendicitis?
Appendicitis is a surgical emergency. The patient should be admitted and closely monitored.
What should be done immediately after diagnosing appendicitis?
The patient should be nil-by-mouth from the time of diagnosis.
What supportive care should be started for appendicitis?
IV fluids and analgesia should be started. Consider IV antibiotics (cefoxitin).
What is the surgical treatment for appendicitis?
Appendectomy should be performed without delay.
What type of appendectomy is associated with fewer risks and faster recovery?
Laparoscopic appendectomy.
What is required post-operatively for appendicitis patients?
Follow-up in clinic.
Appendicitis in Children: Pathophysiology, Risk Factors, Symptoms, and Investigation, management, complications
Appendicitis in Children: Pathophysiology, Risk Factors, Symptoms, and Investigation
Pathophysiology
Appendicitis is the inflammation of the appendix, a small pouch connected to the large intestine. The pathophysiology involves:
Obstruction: The most common cause is the obstruction of the appendiceal lumen, which can be due to fecaliths (hardened stool), lymphoid hyperplasia, or foreign bodies.
Bacterial Proliferation: The obstruction leads to an increase in pressure within the appendix, which reduces blood flow and leads to bacterial overgrowth.
Inflammation and Infection: The bacterial invasion and subsequent immune response cause inflammation, which can progress to infection.
Necrosis and Perforation: If untreated, the continued pressure and infection can cause tissue death (necrosis) and perforation, leading to peritonitis (inflammation of the abdominal lining) or abscess formation.
Risk Factors
Age: Most common in children and young adults, typically between 10-19 years old.
Gender: Slightly more common in males.
Family History: A family history of appendicitis may increase risk.
Diet: Low fiber and high sugar diet may contribute to the risk.
Symptoms
Abdominal Pain: Initially periumbilical (around the belly button) that later localizes to the right lower quadrant (McBurney’s point).
Fever: Mild to moderate fever often accompanies the pain.
Nausea and Vomiting: These often follow the onset of pain.
Anorexia: Loss of appetite is common.
Rebound Tenderness: Pain upon release of pressure in the abdomen.
Guarding: Tensing of the abdominal muscles.
Rovsing’s Sign: Pain in the right lower quadrant upon palpation of the left lower quadrant.
Psoas Sign: Pain with extension of the right thigh.
Investigation
Clinical Examination: Detailed history and physical examination focusing on symptoms and signs of appendicitis.
Laboratory Tests:
Complete Blood Count (CBC): Elevated white blood cell count indicating infection.
C-reactive Protein (CRP): Elevated levels indicate inflammation.
Imaging:
Ultrasound: Often the first imaging choice in children, non-invasive and no radiation exposure. Can show a swollen appendix.
Computed Tomography (CT) Scan: More detailed imaging if ultrasound is inconclusive; shows inflammation, perforation, or abscess.
Magnetic Resonance Imaging (MRI): Alternative to CT to avoid radiation, especially in children.
Summary
Appendicitis in children is a medical emergency characterized by the inflammation of the appendix. Early recognition and intervention are crucial to prevent complications such as perforation. A combination of clinical evaluation, laboratory tests, and imaging studies is employed to confirm the diagnosis and guide treatment, which typically involves surgical removal of the appendix (appendectomy).
Management and Complications of Appendicitis in Children
Management
Preoperative Care:
NPO (Nothing by Mouth): To prepare for potential surgery.
Intravenous Fluids: To maintain hydration.
Antibiotics: Broad-spectrum antibiotics to cover gram-negative and anaerobic bacteria.
Surgical Treatment:
Appendectomy: The definitive treatment for appendicitis.
Open Appendectomy: Traditional method involving a single incision in the lower right abdomen.
Laparoscopic Appendectomy: Minimally invasive method with several small incisions and the use of a camera and specialized instruments. This approach often results in quicker recovery and less postoperative pain.
Non-Operative Management:
Antibiotic Therapy Alone: In select cases of uncomplicated appendicitis (without signs of perforation or abscess), antibiotics alone may be used. This approach is more common in Europe but is gaining some acceptance in the United States for specific patients.
Postoperative Care:
Pain Management: Analgesics to manage postoperative pain.
Wound Care: Keeping the surgical site clean and monitoring for signs of infection.
Activity Restrictions: Limiting strenuous activity for a few weeks post-surgery to allow healing.
Complications
Early Complications:
Perforation: Can occur if diagnosis and treatment are delayed, leading to the contents of the appendix spilling into the abdominal cavity and causing peritonitis.
Abscess Formation: Localized collection of pus that can form after perforation. May require drainage in addition to antibiotics.
Peritonitis: Generalized infection of the abdominal cavity, which can be life-threatening and requires urgent treatment.
Sepsis: A severe systemic response to infection, leading to widespread inflammation and potentially organ failure.
Surgical Complications:
Infection: Wound infections are common and require antibiotics and sometimes drainage.
Bleeding: During or after surgery, which might require additional interventions.
Adhesions: Scar tissue that can form after surgery, potentially causing bowel obstruction in the future.
Postoperative Complications:
Ileus: Temporary cessation of bowel function, causing pain, bloating, and vomiting. Usually resolves with supportive care.
Incisional Hernia: A weakness in the abdominal wall at the site of the surgical incision, which may require further surgery to repair.
Prolonged Recovery: Some children may experience prolonged pain or fatigue following surgery.
Long-term Complications:
Chronic Abdominal Pain: Some children may experience ongoing abdominal pain even after recovery, which may require further evaluation and management.
