Paediatric
Acute appendicitis is one of the most common causes of abdominal pain and the most frequent condition leading to emergent abdominal surgery in children.
Pathophysiology - Obstruction of appendix due to lymphoid hyperplasia or a faecolith
- Leads to ischemia due to vascular compression, thus to bacterial overgrowth
- Then to inflammation and possible rupture
- Process = 72 hrs
- Post-rupture peritonitis
History - Vague periumbilical pain, followed by nausea, vomiting, and anorexia
- Pain moves to lower right quadrant
- Perforation gives transitory relief, followed by more generalised pain
- Nausea and vomiting generally rare, but more common with retrocecal appendices as they irritate the duodenum
- Diarrhoea also uncommon except with a pelvic location which causes irritative stimulation of the rectum (usually not true diarrhoea)
- Severe fever is uncommon and some patients may be afebrile
Physical - Discomfort
- Withdrawn, unmoving
- Patients are often dehydrated or in pain and may be tachycardic or tachypneic
- Typically, maximal tenderness can be found at the McBurney point in the right lower quadrant. However, the appendix may lie in many positions.
- A medially positioned appendix may present as suprapubic tenderness.
- Patients with a laterally positioned appendix often have flank tenderness.
- Patients with a retrocecal appendix may not have any tenderness until it is advanced or perforated.
- Involuntary guarding of the rectus or oblique muscles
- Rovsing sign / psoas sign / obturator sign
- Should always perform rectal exam
- Right-sided tenderness of the rectum is the classic finding in pelvic appendicitis or in pus that pools in the pelvis from an inflamed appendix elsewhere in the abdomen
Differential diagnoses
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