Flashcards in 41. Appendicitis Deck (17):
acute inflammation of the appendix
appendicitis can be due to
1. obstruction by fecalith ( adults)
2. lymphoid hyperplasia ( children)
appendicitis - presentation / signs
1. Initial diffuse periumbilical pain migrates to McBurnay point
4. may perforate ---> peritonitis
5. may elicit psoas sign
6. obturator signs
7. Rovsing sign
8. guarding and rebound
McBurnay point - location
1/3 distance from right anterior superior iliac spine to umbilicus
1. psoas sign
2. obturator signs
3. Rovsing sign
4. Guarding and rebound
if palpation of the left lower quadrant of a person's abdomen increases the pain felt in the right lower quadrant
the examiner rotates the hip by moving the patient's ankle away from the patient's body while allowing the knee to move only inward
passively extending the thigh of a patient lying on his side with knees extended
Appendicitis - DDx
1. diverticulitis ( elderly)
2. ectopic pregnancy
how to rule out ectopic pregnancy
• A 13-year-old boy has sharp pain that started at the umbilicus and then migrated toward the right. What test can confirm the diagnosis?
Ultrasound can confirm appendicitis, but cannot not rule it out if clinical suspicion is high (the painful spot is the McBurney point)
• A boy has 2 days of fever, vomiting, and severe abdominal pain. On work-up, the RLQ is tender and WBC count elevated. What is the treatment?
Surgery (appendectomy for appendicitis)
• In elderly patients, what condition must be included in the differential diagnosis of acute abdominal pain (in addition to appendicitis)?
• A 21-year-old woman presents with diffuse periumbilical pain and nausea. Other than appendicitis, what condition should be ruled out?
Ectopic pregnancy (ruled out by a β-human chorionic gonadotropin test)
• A 7-year-old boy is transferred to your ED for suspected appendicitis. What signs would you check for on your physical exam?
Psoas, obturator, and Rovsing signs, & may see pain at the McBurney point, guarding, and rebound tenderness