CCS Interactive Case 21 Flashcards
1
Q
9 y/o M brought to the office with fever, N/V, anorexia, periumbilical abdominal pain. Fever (101.1F), HDS.
Ddx?
A
Acute appendicitis
Entercolitis 2/2 Campylobacter or Yersinia, Meckel’s diverticulum, intussusception, renal colic
2
Q
Exam?
A
Focused, abdominal, rectal
3
Q
Decreased bowel sounds, voluntary guarding and rebound upon palpation of the RLQ, Rovsing’s sign, Psoas sign
Next step?
A
BMP CBC FOBT UA Abdominal plain film Transabdominal US
[CT abdomen if child is obese or US is equivocal]
4
Q
Leukocytosis w/left shift
Fecalith in RLQ on X-ray
Inflamed appendix on US
Next step?
A
General surgery consult Standard pre-operative orders - PT/PTT/INR, NPO Correct electrolyte abnormalities IV hydration Preoperative ABX (cefoxitin, Amp-sulbactam, cefazolin + metronidazole are all options) - post-operative reserved for gangrenous and perforated appendicitis Pain management Laparoscopic appendectomy D/C 1-2 days after surgery
5
Q
Sequence?
A
Focused exam Transfer to ER Order: IV access, IV NSS 0.9%, CBC, BMP, LFT, FOBT, UA, abdominal US, abdominal x-ray, NPO, PT/INR, PTT (all stat) Morphine IV, continuous Phenergan IV, continuous Advance clock to obtain resutls - leukocytosis, fecalith, inflamed appendix Order cefoxitin IV x1 Consult general surgery stat Advance clock to obtain recs Laparoscopic appendectomy Admit to ward Advance to next available result Appendectomy performed Reevaluate in 4-8 hours Case ends Cancel NPO, IV access Normal diet, counsel patient and parent Dx: acute appendicitis
