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Acute appendicitis

epdiemiology
1. commonest cause of abdo pain in childhood needing surgical intervention
2. occurs @ any age
  1. but common in age 3 +
clinical features of uncomplicated aa
1. Sx
  1. anorexia
  2. vomiting
    1. usually only a few times
  3. abdo pain
    1. initially central and colicky
      1. appendicular midgut colic
      2. then localises to right iliac fossa
        from localised peritoneal inflammation
2. signs
  1. flushed face w/ oral fetor
  2. low grade fever: 37.2-38 deg C
  3. abdo pain aggravated by movement
    1. e.g. walking, coughing, bumps on road when in car
  4. persistent tenderness w/ guarding in right iliac fossa (McBurney's point)
  5. guarding may be absent
    1. retrocaecal appendix
  6. few abdo signs present w/ pelvic appendix
BE AWARE OF PRESCHOOL KIDS
1. diagnosis harder
  1. esp early in disease
2. faecoliths commoner
  1. visible on plain abdo xray
3. perforation may be rapid
  1. 'cause omentum less well developed
    1. fails to surround appendix
  2. signs easy to underestimate
Mx
1. repeated observation & clinical review
  1. v important
    1. to make right diag
  2. appendicitis is progressive
  3. every few hours
2. appendicectomy
  1. uncomplicated appendicitis
    1. straightforward
  2. complicated appendicitis
    1. if guarding present (consistent w/ perforation)
      1. fluid resus and iv Abx before laparotomy
    2. if palpable mass in right iliac fossa
      1. and no signs of generalised peritonitis
        conservative Mx
        iv Abx
        appendicectomy in a few weeks
        if sx progress, laparotomy
Ix
1. no lab or imaging is consistently helpful for diagnosis
  1. neutrophilia not always present on FBC
  2. WBCs or orgs in urine can be present in appendicitis
    1. inflamed appendix can be adj to ureter or bladder
2. ultrasound
  1. may support clinical diag
  2. show thickened, non-compressible appendix w/ increased blood flow
  3. show complications of appendicitis
    1. abscess
    2. perforation
    3. appendix mass
  4. exclude other pathology
3. laparoscopy
  1. in some centres
  2. to see if appendix inflamed
complicated appendicitis
1. presence of appendix mass
2. abscess
3. perforation

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Acute appendicitis

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	Created by v.djabatey over 10 years ago