APPENDICITIS

Question 1

• a small, blind-ended pouch attached to the cecum just below the ileocecal valve
• fills and empties regularly into the
  cecum
  *if it empties insufficiently & its lumen is small, the appendix is prone to obstruction & infection

Answer 1

appendix

Question 2

• refers to the inflammation of the
  vermiform appendix
• most common cause of abdominal surgery in children
  *occurs most frequently in school age children and adolescents

Answer 2

appendicitis

Question 3

causes of appendicitis

Answer 3

obstruction by:
- hardened fecal
- swollen lymphoid tissue
- parasites

Question 4

___ occurs up to 82% of children less than 5 yrs. It can occur within approximately 48 hrs.
of the initial complaint of pain.

Answer 4

perforation

Question 5

signs of peritonitis to WOF

Answer 5

• sudden relief after perforation
• increase in diffuse pain
• abd distention, tachycardia
• shallow breathing
• pallor chills
• irritability, restlessness

Question 6

Point of sharpest pain
(tenderness) is often one third of
the way between the anterior
superior iliac spine and the
umbilicus

Answer 6

mcburney’s point

Question 7

production or intensification of pain when pressure is released

Answer 7

rebound tenderness

Question 8

pain in the right lower quadrant (RLQ) when the examiner palpates the left lower quadrant (LLQ)

Answer 8

rovsing sign

Question 9

The patient, while lying on their back, is asked to lift their right thigh against resistance, which flexes the hip.

Answer 9

psoas sign

Question 10

passively rotating the hip internally while the patient’s knee is flexed at a 90-degree angle

Answer 10

obturator sign

Question 11

true or false - Absence of fever does not exclude appendicitis.

Answer 11

true

Question 12

A child may not be able to walk well and may complain of pain in the
right hip caused by inflammation in the ___ muscles

Answer 12

psoas / iliopsoas

Question 13

appendicitis diagnostic tests

CBC
CRP
UA
serum HCG
UTZ

Answer 13

WBC > 10,000
CRP elevated
UA to rule out UTI
serum HCG to rule out pregnancy
UTZ to reveal swollen appendix

Question 14

complication due to perforation

Answer 14

*Abscess
*Phlegmon
*Enterocutaneous fistula
*Peritonitis
*Partial bowel obstruction
*Sepsis

Question 15

surgical removal before performation

Answer 15

appendectomy

Question 16

tx mgmt

Answer 16

• IVF to correct F&E and prevent DHN
• antibiotics and analgesics

Question 17

additional tx for ruptured appendix

Answer 17

• semi fowlers
• peritoneal cavity irrigation
• placement of drains for infectious material

Question 18

pre-op care

Answer 18

NPO
IVF
antibiotics
NGT
IFC

Question 19

post op care

Answer 19

semi fowlers
pain reliever
NPO
discharge teaching
normal activity resume within 2-4 weeks