Gastroenterology: Appendicitis Flashcards
Is it the most common cause of surgical acute abdominal pain in children?
Yes
Can it occur at any age?
Yes
Among what age group is it uncommon?
Under 3 years
What symptoms are associated?
Anorexia
Vomiting /nausea
Abdominal pain - initially central and colicky, but then localises to RIF
What signs are associated?
Fever (low grade)
Abdominal pain aggravated by movement - walking, jumping, coughing
Persistent tenderness with guarding in RIF (McBurney’s point)
Rebound tenderness
What is McBurney’s point?
2/3 way between umbilicus and ASIS
Are some of the characteristic manifestations absent in younger children?
Yes
When should the diagnosis be considered?
All cases of previously healthy children who have history of abdominal pain and vomiting, with or without fever or focal abdominal tenderness
Are faecoliths more common in children?
Yes - can be seen on AXR
Is the diagnosis more difficult in children?
Yes particularly early on in disease
Why may perforation be rapid?
The omentum is less well developed and fails to surround the appendix
Are laboratory investigations or imaging considered helpful in making a diagnosis?
No
A neutrophilia is not always present on FBC
Appendicitis is a progressive condition, so repeated…
Observations and clinical review every few hours key to making diagnosis
Why is WBCs or organisms in urine not uncommon in appendicitis?
The inflamed appendix may be next to the ureter or bladder
What may an USS show?
Thickened, non compressible appendix with increased blood flow
- may be used to support diagnosis
- may be used to demonstrate associated complications
- exclude other pathology
What complications can occur?
Perforation
Abscess
Mass
How is uncomplicated appendicitis managed?
Appendectomy
If there is generalised guarding consistent with perforation, what should be given prior to laparotomy?
Fluid resuscitation
IV antibiotics
If there is a palpable mass in RIF but no generalised peritonitis, what could be done?
Conservative management with IV antibiotics
Appendectomy after several weeks
If symptoms progress - laparotomy indicated
What causes appendicitis?
Obstruction of appendix lumen by faecolith, normal stool or lymphoid hyperplasia
Most cases are between what age group?
15-59
Do majority present as medical emergencies?
Yes
What investigations are usually done?
FBC
Urinalysis
Pregnancy test if female and of child bearing age
Abdominal USS
