[79] Acute Appendicitis Flashcards

1
Q

Is acute appendicitis serious?

A

Yes, it’s a medical emergency 🚨

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2
Q

What is the basic pathology of acute appendicitis?

A

Inflammation of the appendix

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3
Q

How common is appendicitis?

A

Affects 1/6

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4
Q

Compared to other abdominal emergencies in children, how common is acute appendicitis?

A

The most common

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5
Q

How does acute appendicitis start?

A

Occlusion of the appendix lumen

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6
Q

What often cause the initial obstruction of the appendix lumen?

A

A faecolith

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7
Q

What is a faecolith?

A

A hard pellet of faeces

-lith = stone

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8
Q

How does the initial appendix obstruction present?

A

Vague abdominal pain

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9
Q

Where can vague abdominal pain due to initial appendicitis present?

A

Around the umbilicus (T10)

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10
Q

How does the initial obstruction further develop?

A

The appendix becomes inflamed, eventually involving the full thickness

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11
Q

What can full thickness inflammation of the appendix cause?

A

Irritation of the peritoneum

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12
Q

How does irritation of the peritoneum present?

A

More severe, localised pain

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13
Q

Where does pain due to peritoneal irritation by the appendix present?

A

The RIF

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14
Q

How long can it take for initial appendix obstruction to develop into full thickness inflammation?

A

6-12 hours

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15
Q

What may happen 24-36 hours after onset of RIF pain?

A

The appendix may become gangrenous and rupture

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16
Q

Which gender is acute appendicitis more common in?

A

Male

17
Q

How does household income affect risk of acute appendicitis?

A

More common in children from a high income household

18
Q

Living in what area has a higher risk of acute appendicitis?

A

Living in a rural area

19
Q

What is the typical presentation of early appendicitis?

A

Vague centralised abdominal pain

20
Q

What is the typical presentation of progressed acute appendicitis?

A

Severe RIF pain

21
Q

What can aggravate appendicitis pain?

A

Movement

22
Q

How may a child try to reduce the pain of appendicitis?

A

Lie still with knees flexed

23
Q

Besides pain what other symptoms may acute appendicitis present with?

A
  • Anorexia (not eating food)
  • Vomiting
  • Fever
24
Q

What is elicited upon examination of the abdomen in children with acute appendicitis?

A

Tenderness with guarding in the RIF

25
Q

How is appendicitis usually diagnosed?

A

Clinically

26
Q

Are lab investigations used in appendicitis?

A

Not that useful in diagnosis

27
Q

What investigation can be used to support a diagnosis of appendicitis?

A

USS

28
Q

How accurate is USS in diagnosing appendicitis?

A

90%

29
Q

What will USS of appendicitis show?

A

A thickened, non-compressible appendix with increased blood flow

30
Q

What complications may USS be able to show in acute appendicitis?

A
  • Abscess
  • Perforation
  • Appendix mass
31
Q

What surgical procedure can be used to assess inflammation of the appendix in some centres?

A

Laparoscopy

32
Q

What test is abnormal in 1/3 of patient’s with appendicitis?

A

Urinalysis

33
Q

What aspects of urinalysis are abnormal in 1/3 of appendicitis cases?

A
  • Pyuria

- Bacteriuria

34
Q

In the presence of an abnormal urinalysis, when should antibiotics for suspected UTI be started?

A

Only if dysuria is present

35
Q

What is the key symptom to consider when forming differential diagnoses for acute appendicitis?

A

Acute abdominal pain

36
Q

What are some differential diagnoses (other than appendicitis) for acute abdominal pain in children?

A
  • Gastroenteritis
  • Mesenteric adenitis
  • Meckel’s diverticulitis
  • Intsusception
  • Henoch-Schonlein Purpura
  • UTI
  • Abdominal trauma
37
Q

What is the definitive management for appendicitis?

A

Appendectomy

38
Q

What is suggested if there is generalised guarding?

A

Perforation

39
Q

What additional management should be given in the case of perforation?

A

Fluid resuscitation with IV antibiotics prior to laparotomy