APPENDICITIS

Question 1

DDx: GI

Answer 1

GI:
Regional adenitis
Enteritis/Ileitis
Chron’s
Torsed Epiploicae
Epiploic Adendigitis
Meckel’s diverticulum
Cecal diverticulitis
Mesenteric Lymphadenitis Pancreatitis Constipation Intussusception Perforated Ulcer Volvulus
Tumor

Question 2

DDx: Non-GI

Answer 2

GU: UTI, Pyelonephritis, Nephrolithiasis
Testicular Torsion

Gyn: Ectopic, Ovarian Cyst, Ovarian Torsion, PID

Pulm: PNA

Question 3

Investigations

Answer 3

CBC
Lytes
CRP
U/A

CT Abdo / Pelvis with IV & Oral Contrast
U/S (less reliable)

CXR: to rule out PNA, free air
AXR: non specific

Question 4

Can you have an abnormal U/A with appendicitis?

Answer 4

Yes: hematuria and pyuria due to inflammation of the ureter

Question 5

CT findings with acute appendicitis

Answer 5

Periappendiceal fat stranding
Appendiceal diameter > 6 mm
Periappendiceal fluid
Fecalith

Question 6

Acute Management

Answer 6

1. NPO
2. IV Fluids
3. Antibiotics with anaerobic coverage
4. Consult surgery

Question 7

Treatment of non-perforated appendicitis

Answer 7

Prompt appendectomy
24 hrs antibiotics
Discharge usually on POD #1

Question 8

Treatment of perforated appendicitis

Answer 8

IV fluid resuscitation
Prompt Appendectomy
Post operative antibiotics of 3-7 days (normal WBC, afebrile, ambulating, eating regular diet)

Question 9

Antibiotic choice for non-perforated appendicitis.

Answer 9

Anaerobic coverage: Ceftriaxone 1 g IV od + Metronidazole 500 mg IV bid

Question 10

Antibiotic choice for perforated appendicitis

Answer 10

Pip Tazo 3.75 g IV q 6 hr

Question 11

Post Operative Complications

Answer 11

Bleeding
Trochar Site Cellulitis
Abdominopelvic phlegmon / abscess (more common in perforated appendix)

Question 12

Presentation & Management of abdominopelvic abscess

Answer 12

5-14 day postoperative pain, fever, bowel dysfunction

IV antibiotics
Percutaneous drainage