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19 Cards in this Set
- Front
- Back
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Common symptoms
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poor oral intake, fever, vomiting, migratory abdominal pain
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Pediatric appendicitis score
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Migratory pain, nausea and vomiting, anorexia, fever, cough/percussion/hopping (2), RLQ tenderness (2), WBC > 10K, PMNs >7500
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Meta-analyses comparing lap vs. open appendectomy
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-Decreased length of stay 2.4 hours
-Decreased wound infection 1-2 vs 5-6% -Operative time the same or shorter. -Superior quality of life at 2 weeks. -Reduces rate of postoperative small bowel obstructions. -Also allows thorough inspection of the abdomen to address other etiologies of abdominal pain. |
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Treatment of perforated appendicitis (operative vs. nonoperative)
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Early appendectomy was associated with significantly shorter time to return to normal activities (14 vs 19 d), reduced adverse events (abscess, small bowel obstruction, unplanned readmission, 30 vs. 55%).
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Duration of antibiotics in perforated appendicitis
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Limited data. Many use resolution of pain, return of bowel function, and normalization of WBC and fever.
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Data for duration of therapy in perforated appendicitis
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IV antibiotics for 3 days did not have an increased number of infectious complications compared to those treated for longer periods. However APSA recommends minimum 5 days.
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Randomized data for IV vs PO abx for perforated appendicitis
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IV for 5 days vs. IV until tolerating PO then Augmentin. No difference in postoperative abscess rate. Discharge before day 5 was possible in 42% in IV/PO group.
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Rationale for nonoperative therapy in perforated appendicitis with abscess formation
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Meta-analysis of 56,000 patients, 4% with abscess or phlegmon. 36% who underwent immediate surgery had morbidity, inc postop infection, intestinal fistula, SBO, or recurrence. OR 3.4 compared to the nonoperative group.
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Number of cases per year
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70,000
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Risk lifetime
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8.7% for boys, 6.7% for girls
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Peak incidence
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12 to 18 years
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Rate of postoperative abscess
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1% for acute, 20% for perforated
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Causes of obstruction causing appendicitis
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Lymphoid hyperplasia, inspissated fecal matter, foreign body, parasites
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Next stage in evolution of appendicitis
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Lymphoid and venous congestion, causing edema, and eventually blockage of arterial inflow. Eventually leads to necrosis and perforation.
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Odd causes of appendicitis
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Yersinia, Salmonella, Shigella, mumps, coxsackievirus B and adenovirus. CF kids can get painful distention of the appendix from abnormal mucus production.
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Sensitivity/specificity of ultrasound
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Sens 78% to 94%, specificity 89 to 98%.
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CT sensitivity/specificity
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95% or greater
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DDx of appendicitis
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tubo-ovarian process, Crohn disease, Meckel diverticulum, UTI, pneumonia, gastroenteritis,
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Risk of recurrent appendicitis for nonoperatively managed appendicitis?
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8 to 14% but is short term follow up only. Does not take into account the life expectancy of pediatric patients.
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