|
Acute appendicitis
|
|
|
Clx
|
· N/V, anorexia
Diffuse → Localize (RLQ)
· Initially: diffuse abdominal pain (visceral pain)
· Later: Localized RLQ pain (somatic pain)
· Mild leukocytosis
|
|
PEx
|
· McBurney point tenderness
· Psoas sign: pain with right hip extension
· Obturator sign: pain with right hip internal rotation
· Revising sign: RLQ pain with LLQ palpation
|
|
Dx
|
· Clinical
· CT or US
|
|
Tx
|
· Appendectomy
|
· diarrhea only with retrocecal appendicitis
· Blumbergsign: rebound tenderness at McBurney’s point
· Psoas/Obturator sign: raise the patient’s right leg with the knee flexed –> rotate the leg internally at the hip –> increased abdominal pain indicates a positive obturator sign
· Rovsing’ssign: pressure over the LEFT colon causes pain in the RLQ
· if u are not sure ––> CT.
Examination signs in appendicitis:
|
Sign
|
Findings
|
Significance
|
|
Peritoneal signs
· Rebound tenderness
· Involuntary guarding
· Abdominal rigidity
|
· Acute increase in pain after removing the hand from applying pressure
· Tensing of abdominal wall muscles during palpation of abdomen
· Persistent tension of abdominal wall muscles
|
Peritoneal irritation (rupture or impending rupture)
|
|
Psoas sign
|
RLQ pain with extension of right thigh
|
Abscess adjacent to psoas or retrocecal appendix
|
|
Obturator sign
|
RLQ pain with internal rotation of right thigh
|
Pelvic appendix or abscess
|
|
Rovsing’s sign
|
RLQ pain with LLQ palpation and retropulsion of colonic contents
|
Acute appendicitis
|
|
Rectal tenderness
|
· Right pelvic pain during rectal examination, especially with pressure on right rectal wall
|
Pelvic appendix or abscess
|
|
Psoas Abscess
|
|
|
RF
|
· IVDU
· HIV
· DM
· Crohn’s
|
|
Path
|
Spread from another infxn
|
|
S/S
|
· Fever
· Lower abd pain → groin
· Psoas sign: abdominal pain w/ hip extension
|
|
Dx
|
· Leukocytosis
· CT is needed for dx
|
|
Tx
|
Abx + Drainage
|
Fast HY Review 