Appendicitis
General Overview
General Overview
- 50% atypical presentation
- Retrocecal appendix (eg. right flank or pelvic pain)
- Gravid uterus (eg. RUQ pain)
- Clinical decision rules: Alvarado Score, Pediatric Appendicitis Score
Classic Symptoms
Classic Symptoms
- Periumbilical migrating to RLQ pain, anorexia, fever, N/V
- DDx: IBD, ruptured cyst, abscess, ectopic pregnancy, testicular torsion
Physical exam
Physical exam
- Vitals, ABC
- Resp
- Abdominal Exam
- McBurney's sign (tenderness 1/3 from ASIS to umbilicus); +LR 7.31, -LR 0.28
- Psoas sign (pain on flexion of hip against resistance or passive hyperextension of hip); +LR 2.38, -LR 0.9
- Rovsing sign (tenderness of the left abdomen causes pain at McBurney's point)
- Obturator sign (pain on flexion then external/internal rotation of right hip)
- Gyne/Testicular
- Rectal
Management
Management
- ABC
- Intravenous fluids
- NPO/ Bowel rest
- Consider antibiotics
- Consider prophylactic antibiotics (Cefoxitin/Cefotetan/Cefazolin PLUS Metronidazole) 60 mins prior to surgery
- If surgery delayed until next day, consider empiric antibiotics (Ertapenem, Pip-Tazo, Cefazolin/Ceftriaxone/Cipro/Levo PLUS Metronidazole)
- Surgical consult for appendectomy
References:
- UTD