Appendicitis resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Management

Diagnostic Approach

Shown below is an algorithm depicting the therapeutic approach to appendicitis

Characterize the symptoms ❑ Typical symptoms ♦ Abdominal pain(right anterior iliac fosa) ♦ Anorexia ♦ Nausea and vomiting ❑ Atypical symptoms (common at extremes of age) ♦ Indigestion ♦ Flatulence ♦ Bowel irregularity ♦ Diarrhoea ♦ General malaise

Examine the patient ❑ Vitals ♦ Temperature: low grade fever of 101.0 Fº (higher fever as inflammation progreses) ♦ Heart rate: Tachycardia associated to fever ❑Abdomen ♦ McBurney's point tenderness ♦ Rovsing's sign ♦ The psoas sign is related to retrocecal appendix ♦ Obturator sign ❑ Skin ♦ Diaphoresis may be present ♦ Pallor

Order labs ❑ Complete blood count: leukocytosis ❑ Electrolytes ❑ Urea

Differential diagnosis ❑ Intestinal obstruction ❑ Acute cholecystitis ❑ Perforated peptic ulcer ❑ Mesenteric adenitis ❑ Urinary tract infection ❑ Ectopic pregnancy ❑ Torted ovarian cyst

Suspected appendicitis

Imagining study ❑ Helical CT of the abdomen and pelvis with intravenous contrast ❑ Diagnostic imaging should be performed to all female patients ❑ Patients with first trimester of pregnancy should undergo ultrasound or magnetic resonance ❑ If these studies do not define the diagnose, laparoscopy or CT scanning may be considered