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28 Cards in this Set
- Front
- Back
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1. Classic presentation of appendicitis?
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a. Classically begins periumbilically and then migrates to RLQ.
b. Definitive diagnosis may not be made until surgery c. Anorexia, Nausea, and vomiting that being after the onset of pain is strongly indicative of the diagnosis. d. Note: Emesis usually follows rather than precedes, the onset of pain. |
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2. Varied presentations of appendicitis?
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a. Pain may occur laterally: Retrocecal appendix
b. May be more diffuse: (perforated appendix w/resultant peritonitis). |
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3. Appendicitis?
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a. Appendix inflammation occurs after luminal obstruction.
b. If the appendix is not removed, appendiceal wall necrosis results in perforation and peritoneal contamination. |
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4. McBurney’s point?
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a. 2/3 of way from umbilicus to ASIS. Just think of ASIS side.
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5. Psoas sign?
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a. Irritation of the psoas muscle caused by passive hip extension in pts w/appendicitis
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6. Obturator sign?
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a. Irritation of the obturator muscle caused by passive internal rotation of the thigh in pts w/appendicitis.
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7. Peak incidence of appendicitis?
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a. Adolescence.
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8. Aetiologies of appendicitis?
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a. Intrinsic obstruction: inspissated fecal material (appendicolith) is found in 30-50% of pts at the time of surgery.
b. Extrinsic compression: Usually an enlarge LN associated w/bacterial or viral infections. c. The obstruction causes vascular thrombosis, ischaemia, and ultimately, perforation. |
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9. What are you likely to see in the child w/appendicitis when observing there movements?
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a. They are careful in their movements, avoiding sudden actions such as jumping on or off the table.
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10. Examination of abdomen?
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a. Auscultated for bowel sounds first
b. Then gently palpated for the area of maximal tenderness and rigidity. c. Gentle finger percussion assesses for peritoneal irritation “rebound tenderness”. d. If performed, a rectal exam should occur last. |
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11. Labs for appendicitis?
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a. Although not a specific finding, leukocytosis w/a predominance of pmns “left shift” on CBC supports an inflammatory process.
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12. Utility of plain radiographs?
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a. Frequently obtained but infrequently helpful.
b. The following support the dx of appendicitis? 1. Psoas shadow obliteration 2. RLW intestinal dilation 3. Scoliosis toward the affected region. 4. Appendicolith (seen in 10-20% of cases) c. Chest radiographs eliminate pneumonia as an alternate diagnosis |
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13. What test is particularly useful for suspected appendicitis?
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a. Ultrasound. More sensitive than plain films.
b. Particularly useful for females adolescents to evaluate for ovarian cyst and pregnancy. |
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14. Diagnostic test of choice in most centres for appendicitis?
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a. CT.
b. Particularly helpful in pts who are neurologically impaired, immunologically suppressed, or obese. c. Or when perf is suspected. d. CT images are used as a guide for periappendiceal abscess drainage. |
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15. Definitive tx of appendicitis?
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a. Appendectomy.
b. Accomplished as soon as diagnosis is strongly suspected to prevent perforation (if it has not already occurred). |
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16. Additional tx required for perforated appendix?
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a. IV abx and fluid replacement.
b. Maybe complicated by sepsis. Abscess formation, or prolonged (4-5 day) paralytic ileus. |
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17. Partial Differential diagnosis of acute abdominal pain in children beyond infancy?
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1. Appendicitis
2. Bacterial enterocolitis 3. Cholecystisis 4. Constipation 5. Diabetic ketoacidosis 6. Ectopic pregnancy 7. Gastroenteritis 8. Haemolytic-Uraemic syndrome 9. Henoch-Schonlein purpura 10. Hepatitis 11. Inflammatory bowel disease 12. Mittelschmerz 13. Nephrolithiasis 14. Ovarian cyst 15. Pancreatitis 16. PID 17. Pneumonia 18. Strep pharyngitis 19. UTI. |
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18. S/S consistent with: Bacterial enterocolitis?
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a. Diarrhea (may be bloody)
b. Fever c. Vomiting |
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19. S/S consistent with: Cholecystitis?
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a. RUQ pain, often radiating to subscapular region of back
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20. S/S consistent with: Constipation?
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a. Infrequent, hard stools, and recurrent abdominal pain
b. Sometimes enuresis |
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21. S/S consistent with: Diabetic Ketoacidosis?
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a. Hx of polydipsia, polyuria, and wt. loss
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22. S/S consistent with: Ectopic pregnancy?
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Lower abdominal pain
b. Vaginal bleeding c. Abnormal menstrual hx |
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23. S/S consistent with: Gastroenteritis?
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a. Fever, vomiting, hyperactive bowel sounds
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24. S/S consistent with: HUS?
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a. Irritability
b. Petechiae c. Oedema |
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25. S/S consistent with: HSP?
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a. Purpuric lesions, especially of lower extremities and joint pain
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26. S/S consistent with: Hepatitis?
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a. RUQ pain & jaundice
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27. S/S consistent with: IBD?
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a. Weight loss
b. Diarrhea c. Malaise |
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28. S/S consistent with: Mittelschmerz?
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a. Sudden onset of right or left lower quadrant pain w/ovulation, copious mucoid vaginal discharge.
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