Acute Appendicitis Overview (for an intern at 2:00 am)
Pathophysiology: Etiology: fecalith obstructing lumen (more common in adults) or lymphatic tissue blocking lumen (kids) Appendix distends as bacteria proliferate Patient presentation: RLQ pain that begins periumbilical and migrates toward the ASIS. McBurney's point will have tenderness to deep palpation. It is 2/3rds between umbilicus and ASIS. Anorexia is a key feature in the patient's history. If no anorexia, then it is less likely to be appendicitis. Diffuse peritonitis indicates perforation. Fever Nausea/vomiting vomiting → dehydration → increased BUN:Cr ratio What other signs on exam can point to appendicitis? Roving sign: tenderness in RLQ with palpation of LLQ Psoas sign: tenderness in RLQ with passive extension of the hip Pt lies in left lateral decubitus position May indicate a retrocecal appendix Obturator sign: RLQ tenderness with flexion of knee and hip and internal rotation of hip Indicates a pelvic appendix in close proximity to the obturator intern...