RLQ - Acute Abdomen/Appendicitis - Week 3

Question 1

What does the mnemonic PATELLA stand for, and what is the typical order of symptoms in acute appendicitis?

Answer 1

• P: pain (typically first symptom to appear)
• A: anorexia, nausea and/or vomiting
• T: tenderness somewhere
• E: elevated temperature
• L: leukocytosis
• L: lying still
• A: asleep

Question 2

What is the presentation of the typical iliac appendicitis?

Answer 2

Before perforation

• Epigastric pain, later McBurney’s
• Psoas rigidity and/or irritability
• Fever of up to 102.5
• Later distension

After perforation

• RLQ rigidity and/or irritability
• Fever of up to 104.5

Symptoms

• Constipation
• Indigestion
• Epigastric pain shifting to RLQ pain
• Anorexia, N/V
• Local tenderness
• Passing gas, but without relief

Question 3

What is the presentation of ascending appendicitis?

Answer 3

Before perforation

• Flank pain
• Quadratus lumborum rigidity and/or irritability
• Fever of less than 102.5
• Later distension

After perforation

• Quadratus lumborum rigidity and/or irritability
• Fever of up to 104.5

Question 4

What is the presentation of pelvic appendicitis?

Answer 4

Before perforation

• Epigastric or periumbilical pain
• Rectal exam (+) for pain
• Muscle rigidity and/or irritability is often absent
• Fever of less than 102.5
• Later distension

After perforation

• Epigastric or RLQ and LLQ pain, especially at brim of pelvis
• Rectal exam (+) for pain
• Obturator internus rigidity and/or irritability
• Fever of up to 104.5

Question 5

What is the presentation of retrocecal appendicitis?

Answer 5

Before perforation

• Less pain/local pain only
• Muscle rigidity and/or irritability is little
• Fever of less than 102.5
• Often early distension

After perforation

• May be no local pain, but rectal tenderness
• RLQ/illiacus, quadratus lumborum rigidity and/or irritability
• Fever of up to 104.5

Question 6

**How is functional testing used to check for open and closed ileocecal valve syndrome?

Answer 6

• ??
• Know that right lower quadrant pain, dizziness, chronic right shoulder problems, and tinnitus are possible symptoms
• Know that adrenal imbalances and lack of adequate calcium may be causes

Question 7

*What is the function of the appendix?

Answer 7

[- storehouse for commensal flora]

Question 8

What are three homeopathic remedies for acute appendicitis?

Answer 8

• Bryonia
• Belladonna
• Iris tenax

Question 9

*Why does acute appendicitis usually cause constipation?

Answer 9

[- irritation of the cecum -> increased IC valve tone]

Question 10

What are two important differentials in women with signs and symptoms of appendicitis?

Answer 10

• Acute salpingitis

- Ectopic pregnancy

Question 11

What might mimic acute appendicitis in children?

Answer 11

• Mesenteric lymphadenitis