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AppendicitisBROOKE BENTLEY, PHD, APRN

Appendicitis

Appendix = small, fingerlike appendage (4 inches) attached to cecum; fills with food and empties into cecum; small lumen; prone to obstruction and infection

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Etiology

� Obstruction is commonly caused by

a fecalith

Incidence & Demographics

� Most common in people age 10-30 with peak incidence at 15-24

� In patients >50 yo and <5 yo, classic symptoms less frequent, although

perforation is more common, with a higher mortality & morbidity

� A ruptured appendix occurs in one half of children under 6 yo with

appendicitis

� Most common cause of abdominal pain requiring surgery in childhood &

adolescence

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History

� Pain begins gradually; starts as vague, colicky, cramping, and

poorly localized to the periumbilical or epigastric area

� Later becomes localized to the right lower quadrant (RLQ)

� Anorexia, abdominal pain, nausea and vomiting are most

common symptoms (in this order)

Physical Exam

� Fever usually 99-101 degrees F

� Patients frequently flex the right lower extremity when supine to relieve

muscle tension

� May have decreased bowel sounds

� Maximum abdominal tenderness & rigidity occurs over the right rectus

muscle (McBurney’s point)

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McBurney’s Point

Psoas Sign� Psoas Sign involves:

� 1. placing patient in supine position and putting pressure on the right leg

above the knee while the patient attempts to move his or her right hip against

the pressure OR

� 2. placing patient in left lateral position and extending the patient’s right leg

at the hip

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Obturator Sign

� Obturator Sign: the internal rotation of the right leg with the leg flexed to

90 degrees at the hip and knee and a resultant tightening of the internal

obturator muscle may cause abdominal discomfort indicative of

appendicitis

Rovsing’s Sign

� Rovsing’s Sign: If palpation of the left lower quadrant of a person's

abdomen increases the pain felt in the right lower quadrant, the patient is

said to have a positive Rovsing's sign and may have appendicitis

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Rebound Tenderness

� Rebound tenderness: increase in pain when the pressure is released

Markle Test (Heel Jar)

� raise heels & drop suddenly OR jump in place

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Physical Exam

� A pelvic exam on all females with lower abdominal pain to rule

out pelvic inflammatory disease (PID), adnexal mass, ectopic

pregnancy, or uterine pathology

Other Differential Diagnoses

� Ectopic pregnancy

� Pelvic inflammatory disease

� Testicular

� Gastroenteritis

� Urinary tract infection

� Inflammatory bowel disease

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Diagnostics

� 1. If thinking acute abdomen: appendicitis

�Consult with surgeon

� 2. If NOT acute abdomen:

�Other diagnostics based on differential diagnoses