APPENDICITIS

 

S&S:

  1. Pain that starts in epigastrium and migrates to RLQ usually within 1-12hrs. Onset of pain is not sudden = 60%.
     
  2. Anorexia = 40-50%.  Usually precedes pain.
     
  3. Nausea/Vomiting/Diarrhea = 50%-40%-15% respectively.
     
  4. Low grade temp = 70%.
     
  5. McBurny's, Rovsing, Psoas/Obturator signs.
     
  6. Rectal/Pelvic exam are essential and show localized pain in RLQ.
    Fluctuance /tenderness in the RLQ may be appreciated  on DRE and is
    very useful diagnostically.
     
  7. Cutaneous  hyperesthesia @ T10-T12 may be present.

DX:

  1. History/physical
  2. ­ WBC (10-16 K  with shift)
  3. In certain centers C-Reactive Protein (CRP) is used to add to diagnostic tools. It is about 60% sensitive and specific when symptoms are  present for 12 hours.
  4. UA may show few RBC/WBCs if appendix overlies ureter or bladder.
  5. US. The diagnosis with US is 90% sensitive and 95% specific but is very  technician dependent.
  6. CT scan with IV/PO/rectal i.e. triple contrast yields highest sensitivity/specificity.

Treatment:

  1. Antibiotics once definitive diagnosis is made.
     
  2. Appendectomy.

 

Differential Diagnosis:

IBD, Ovarian Cyst, Ovarian Torsion, Intestinal Obstruction, Strangulated Hernia, Mesenteric Adenitis/TB,  PID, HZ, Renal Stone, Ectopic pregnancy, Sickle Crisis, Testicular Torsion, Mittleshmertz, Gastroenteritis.

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