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  • Acute Appendicitis

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    Appendicitis is the most common condition requiring emergency surgery in children. It occurs in about 7% of individuals, peaking between ages 10-30 and affecting males more than females. The classic presentation involves vague abdominal pain that migrates to the lower right quadrant, accompanied by anorexia, nausea and vomiting. A physical exam typically reveals tenderness in the lower right abdomen with fever. Laboratory tests and imaging studies like ultrasound and CT scans are used to confirm the diagnosis before an appendectomy is performed.

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    Appendicitis is the most common condition requiring emergency surgery in children. It occurs in about 7% of individuals, peaking between ages 10-30 and affecting males more than females. The classic presentation involves vague abdominal pain that migrates to the lower right quadrant, accompanied by anorexia, nausea and vomiting. A physical exam typically reveals tenderness in the lower right abdomen with fever. Laboratory tests and imaging studies like ultrasound and CT scans are used to confirm the diagnosis before an appendectomy is performed.

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    26 views15 pages

    Acute Appendicitis

    Uploaded by

    Ratna pada
    Appendicitis is the most common condition requiring emergency surgery in children. It occurs in about 7% of individuals, peaking between ages 10-30 and affecting males more than females. The classic presentation involves vague abdominal pain that migrates to the lower right quadrant, accompanied by anorexia, nausea and vomiting. A physical exam typically reveals tenderness in the lower right abdomen with fever. Laboratory tests and imaging studies like ultrasound and CT scans are used to confirm the diagnosis before an appendectomy is performed.

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    of 15

    Appendicitis

    Dr. H. Nikijuluw, SPB-KBD


    Appendicitis: Epidemiology
    Most common condition requiring emergency
    surgery in children
    ~1 in 15 individuals (7%) develop
    appendicitis
    Peak incidence occurs between 10 to 30 y/o
    Male:Female = 2:1
    1/3 of cases have associated rupture
    <1% mortality overall, increases to ~5% in
    young & elderly
    Appendicitis: Epidemiology
    Up to 30% of appendices are hidden
    Not peritoneal
    Pelvic, retroileal or retrocolic
    Appendicitis:
    Pathophysiology
    Luminal obstruction
    Appendicoliths, parasites (ascaris,
    enterobius), FB, carcinoid, CF (inspissated
    mucus), lymphoid hyperplasia
    Distal mucous production & bacterial
    overgrowth
    Distention Diminished perfusion
    Ischemia Perforation
    Appendicitis: Classic
    Presentation
    Vague periumbilical pain
    Anorexia, nausea, vomiting
    Migration of pain to RLQ
    Fever
    Appendicitis: Common
    Symptoms
    Abdominal pain ~100%
    Anorexia ~100%
    Nausea ~90%
    Vomiting ~75%
    Pain Migration ~50%
    Classic symptom sequence ~50%
    Symptoms lasting over 24-36 hr is
    uncommon in nonperforated appendicitis
    Appendicitis:PE
    RLQ pain tenderness
    Fever typically low grade 38.0C
    Peritoneal signs
    Rebound tenderness best identified
    with percussion
    Guarding
    Appendicitis: PE
    Other confirmatory peritoneal signs
    Psoas sign
    Pain on extension of R thigh
    Retroperitoneal retrocecal appendix

    Obturator sign
    Pain on internal rotation of R thigh
    Pelvic appendix

    Rovsings sign
    Pain in RLQ with palpation of LLQ
    Appendicitis: Lab Evaluation
    WBC > 10,000
    Occurs in 80% of cases of appendicitis
    Occurs in 70% of other causes of RLQ
    pain
    UA
    May show mild pyuria, proteinuria &
    hematuria
    Usually used to r/o urinary tract causes
    Appendicitis: Radiologic
    evaluatuion
    KUB
    Non-specific
    Ultrasound
    Sensitivity 85%
    Specificity 92%
    CT scan
    Sensitivity 90 100%
    Specificity 95 97%
    Appendicitis: Ultrasound
    Advantages Disadvantages
    Safe Operator
    Relatively Dependant
    inexpensive Technically
    Can r/o pelvic inadequate studies
    disease in females due to bowel gas
    Pain
    Appendicitis: CT
    Advantages Disadvantages
    More accurate Cost
    Better identifies Ionizing radiation
    phlegmon & abcess Contrast
    Better identifies
    normal appendix
    Appendicitis: Treatment
    Nonperforated
    Appendectomy
    National rate of negative appendectomies ~20%
    Perforated
    Surgery immediate vs. delayed
    Nonoperative mangement
    Antibiotics
    Observation
    CT guided drainage
    Questions????

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