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Appendicitis – Peds Exam Questions with Latest Update
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Appendicitis – Peds Exam Questions with Latest Update
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Appendicitis – Peds Exam Questionswith Latest Update
What is appendicitis? - Answer-inflammation of the vermiform appendix (blind sac at the
end of the cecum)
How common is appendicitis? - Answer-It is the most common cause of emergency
abdominal surgery in childhood with 70,000 cases per year affecting children mostly
around 10 years old; boys and girls are affected equally before puberty.
What are some of the first symptoms of appendicitis? - Answer-periumbilical pain
followed by nausea, RLQ pain (may not be first) and vomiting with fever
When does perforation typically occur? - Answer-around 48 hours after the initial
complain of pain; it occurs in 20-40% of children w/ appendicitis
What are some complications of appendiceal perforation? - Answer-major abscess,
phlegmon, enterocutaneous fistula, peritonitis, and partial bowel obstruction
What is a phlegmon? - Answer-an acute suppurative inflammation of subcutaneous
connective tissue
What causes appendicitis? - Answer-obstruction of the lumen of the appendix usually by
hardened fecal material (fecalith); swollen lymphoid tissue after viral infection; and
parasites such as pinworms - enterobius vermicularis (rare)
Describe the pathophysiology of appendicitis? - Answer-obstruction causes the outflow
of mucus secretions to be block and pressure builds in the lumen resulting in
compression of blood vessels; this causes ischemia followed by ulceration of the
epithelial lining and invasion of bacteria; necrosis follows and cause perforation or
rupture w/ fecal matter and bacteria contaminating the peritoneal cavity; this results in
peritonitis; progressive peritoneal inflammation results in an ileus of the small bowel and
inhibition of motility; loss of EFC to the peritoneal cavity results in electrolyte imbalances
and hypovolemia.
How is appendicitis diagnosed? - Answer--Not always straight forward (symptoms may
be from many things; more of process of elimination)
-Based on H&P
-May be elevated WBC (>10,000) and C-reactive protein (CRP) but it is not specific to
appendicitis
-Must rule out other causes (Urinalysis to rule out UTI; pregnancy test in females over
10 to rule out ectopic pregnancy)
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