GASTRO/GENSURG
APPENDICITIS
PromptClinical features suggesting appendicitis
ResponsePaediatric appendicitis score:
Anorexia
Nausea/vomiting
Fever
Migration of pain
Tenderness in RIF (2)
Cough/percussion/hopping tenderness (2)
Leukocytosis
Neutrophilia
Rovsings/Obturator/Psoas sign
Anorexia
Nausea/vomiting
Fever
Migration of pain
Tenderness in RIF (2)
Cough/percussion/hopping tenderness (2)
Leukocytosis
Neutrophilia
Rovsings/Obturator/Psoas sign
PromptTests to exclude other pathology in suspected appendicitis
ResponseGlucose - DM/DKA
Urine dipstick/urgent micro - UTI
Lipase - pancreatitis
CXR - perforation/LRTI
US - Intussusception
Urine dipstick/urgent micro - UTI
Lipase - pancreatitis
CXR - perforation/LRTI
US - Intussusception
PromptUltrasound findings in appendicitis
ResponseAperistaltic, non compressible dilated appendix >6mm in diameter
Distinct thickened appendiceal wall layers >3mm, but if necrotic/gangrenous there will be loss of wall stratification
Absces/collection if perforated
Echogenic, prominent periappendiceal fat, increased vascularity
Target appearance in axila section
Increase free fluid (more than physiologic amount)
Distinct thickened appendiceal wall layers >3mm, but if necrotic/gangrenous there will be loss of wall stratification
Absces/collection if perforated
Echogenic, prominent periappendiceal fat, increased vascularity
Target appearance in axila section
Increase free fluid (more than physiologic amount)
PromptUtility of ultrasound in appendicitis
ResponseMay confirm diagnosis if appendix is visualised
If appendix not visulised (eg: retrocoecal) cannot exclude diagnosis of acute appendicitis - (Need to rely clinically)
May demonstrate alternate pathology - Ovarian/iliitis/hydronephrosis
Simple/repeatable/no radiation is not a consultant level answer
If appendix not visulised (eg: retrocoecal) cannot exclude diagnosis of acute appendicitis - (Need to rely clinically)
May demonstrate alternate pathology - Ovarian/iliitis/hydronephrosis
Simple/repeatable/no radiation is not a consultant level answer