Emedicine article on paediatric appendicitis
Acute appendicitis is one of the most common causes of abdominal pain and the most frequent condition leading to emergent abdominal surgery in children.
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
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
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