Apendicitis =========== þ Appendicitis Etiology and Natural History: - thought to be obstruction by a fecalith - Classical Presentation: periumbilical pain and anorexia, followed by vomiting and right lower quadrant pain -- seen about 60% of the time. - sometimes, after perforation, a piece of omentum will wall off the area, forming an abscess; otherwise, generalized peritonitis results. - pertonitis more likely in young children due to less omentum þ Appendicitis in Pediatrics - CT with standard adult protocol appropiate and useful [Sivit CJ et al. Evaluation of suspected appendicitis and young adults: helical CT. Radiology 2000 Aug;216(2):430-3] - Children with appendicitis twice as likely to have + FH than surgical controls without abdominal pain. [Gauderer MW et al. Acute appendicitis in children: the importance of family history. J Pediatr Surg 2001 Aug;36(8):1214-7.] þ Physical Exam and Testing for Appendicitis þ Causes of "pseudo-appendicitis" þ Acceptable used to be 20% false positive in OR þ Role of antibiotics in appendicitis: - "Most clinicians do administer broad-spectrum antibiotics in these patients. The antibiotics are usually stopped after surgery if there is no perforation." [emedicine.com - http://www.emedicine.com/emerg/topic361.htm (Tucker [au] and Bechtel [ed])]