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8 Cards in this Set
- Front
- Back
Acute Appendicitis: H&P: classic presentation
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Classic chronologic order:
1. Periumbilical pain (intermittent andcrampy) 2. Nausea/vomiting 3. Anorexia 4. Pain migrates to RLQ (constant andintense pain), usually in 24 hours |
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Acute Appendicitis: peritoneal signs
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Signs of peritoneal irritation may be
present: guarding, muscle spasm, rebound tenderness, obturator and psoassigns, low-grade fever (high grade if perforation occurs), RLQ hyperesthesia |
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Acute Appendicitis: Differential Diagnosis:
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Everyone?
Meckel’s diverticulum, Crohn’s disease, perforated ulcer, pancreatitis, mesenteric lymphadenitis, constipation, gastroenteritis, intussusception, volvulus,tumors, UTI (e.g., cystitis), pyelonephritis, torsed epiploicae, cholecystitis, cecal tumor, diverticulitis (floppy sigmoid) Females? Ovarian cyst, ovarian torsion, tuboovarianabscess, mittelschmerz, pelvic inflamma- tory disease (PID), ectopic pregnancy, ruptured pregnancy |
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Acute Appendicitis: What lab tests should be performed?
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CBC: increased WBC (10,000 per mm3in 90% of cases), most often with a
“left shift” Urinalysis: to evaluate for pyelonephritis or renal calculus |
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Acute appendicitis: imaging/ findings
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Spiral CT, U/S (may see a large,
noncompressible appendix or fecalith),AXR CT findings:Periappendiceal fat stranding, appendiceal diameter 6 mm,periappendiceal fluid, fecalith AXR findings: Fecalith, sentinel loops, scoliosis away from the right because of pain, mass effect(abscess), loss of psoas shadow, loss of preperitoneal fat stripe, and (very rarely) asmall amount of free air if perforated |
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Acute Appendectomy: management and intervention
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Preop: IVF and ABX w. anaerobes coverage (Anaerobic coverage: Cefoxitin®, Cefotetan®, Unasyn®, Cipro®, and Flagyl®)
Op: lap appy |
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Acute Appendicitis: management and intervention exceptions:
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Nonperforated—prompt appendectomy(prevents perforation), 24 hours of
antibiotics, discharge home usually on POD #1 Perforated—IV fluid resuscitation and prompt appendectomy; all pus is drained with postoperative antibiotics continued for 3 to 7 days; wound is left open in most cases of perforation after closing thefascia (heals by secondary intention or delayed primary closure) Appendiceal abscess:Usually by percutaneous drainage of theabscess, antibiotic administration, and elective appendectomy 6 weeks later |
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Acute Appendicitis: management and intervention: What ABXs should be used for perforated appendix?
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Broad-spectrum antibiotics (e.g.,
Amp/ Cipro®/Clinda or a penicillin such as Zosyn®) |