Appendicitis (peds) - Revision history

Danbot: Strip excess bold

2026-03-22T09:31:48Z

Strip excess bold

Ostermayer: Marked this version for translation

2026-01-15T17:15:15Z

Marked this version for translation

Show changes

Ostermayer: Prepared the page for translation

2026-01-15T17:14:43Z

Prepared the page for translation

Show changes

Ostermayer at 12:57, 15 January 2026

2026-01-15T12:57:14Z

← Older revision		Revision as of 12:57, 15 January 2026
Line 1:		Line 1:
	{{~~Peds top~~}} ~~[[appendicitis]]~~		{{PediatricPage\|Appendicitis}}
	==Background==		==Background==
	[[File:Appendix locations.png\|thumb\|Drawing of colon with variability of appendix locations as seen from anterior view.]]		[[File:Appendix locations.png\|thumb\|Drawing of colon with variability of appendix locations as seen from anterior view.]]

Rossdonaldson1: /* Laboratory Findings */

2024-02-14T21:49:59Z

Laboratory Findings

← Older revision		Revision as of 21:49, 14 February 2024
Line 109:		Line 109:
	**Consider LFTs + lipase		**Consider LFTs + lipase
	**Consider coagulation studies (PT, PTT, INR), as a marker of liver function		**Consider coagulation studies (PT, PTT, INR), as a marker of liver function
	*Consider [[urine pregnancy]] (age appropriate)		*Consider urine pregnancy test (age appropriate)
	*[[Urinalysis]]		*[[Urinalysis]]
	**7-25% of patients with appendicitis have [[sterile pyuria]]		**7-25% of patients with appendicitis have [[sterile pyuria]]

Rossdonaldson1: /* Laboratory Findings */

2024-02-14T21:49:35Z

Laboratory Findings

← Older revision		Revision as of 21:49, 14 February 2024
Line 109:		Line 109:
	**Consider LFTs + lipase		**Consider LFTs + lipase
	**Consider coagulation studies (PT, PTT, INR), as a marker of liver function		**Consider coagulation studies (PT, PTT, INR), as a marker of liver function
	*Consider urine pregnancy (age appropriate)		*Consider [[urine pregnancy]] (age appropriate)
	*[[Urinalysis]]		*[[Urinalysis]]
	**7-25% of patients with appendicitis have [[sterile pyuria]]		**7-25% of patients with appendicitis have [[sterile pyuria]]

Rossdonaldson1: /* Preschool (2 - 5yrs) */

2024-02-14T21:48:36Z

Preschool (2 - 5yrs)

← Older revision		Revision as of 21:48, 14 February 2024
Line 33:		Line 33:
	**Anorexia		**Anorexia
	*Physical		*Physical
	**RLQ tenderness		**[[RLQ tenderness]]

	===School-age (6 - 12yrs)===		===School-age (6 - 12yrs)===

Rossdonaldson1: /* Antibiotics */

2024-02-14T21:48:13Z

Antibiotics

← Older revision		Revision as of 21:48, 14 February 2024
Line 140:		Line 140:

	===[[Antibiotics]]===		===[[Antibiotics]]===
	*[[Antibiotics]]		*[[Ampicillin/sulbactam]] '''OR''' [[cefoxitin]]
	**[[Ampicillin/sulbactam]] '''OR''' [[cefoxitin]]		*Penicillin allergy?
	**Penicillin allergy?		**[[Gentamicin]] + ([[clindamycin]] '''OR'''
	***[[Gentamicin]] + ([[clindamycin]] '''OR'''		**[[metronidazole]])
	***[[metronidazole]])		*Perforation or complicated appendicitis<ref>Yardeni D et al. Single daily dosing [[ceftriaxone]] and [[metronidazole]] vs standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomized trial. J Pediatr Surg. 2008 Jun; 43(6): 981–985.</ref>
	**Perforation or complicated appendicitis<ref>Yardeni D et al. Single daily dosing [[ceftriaxone]] and [[metronidazole]] vs standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomized trial. J Pediatr Surg. 2008 Jun; 43(6): 981–985.</ref>		**IV antibiotic regimen as below:
	***IV antibiotic regimen as below:		***[[Ampicillin]] 100 mg/kg/d q6hr, max 8 g per dose '''AND'''
	****[[Ampicillin]] 100 mg/kg/d q6hr, max 8 g per dose '''AND'''		***[[Gentamicin]] 5 mg/kg QD, max 300 mg '''AND'''
	****[[Gentamicin]] 5 mg/kg QD, max 300 mg '''AND'''		***[[Metronidazole]] 30 mg/kg/d q8hr, max 1.5 g
	****[[Metronidazole]] 30 mg/kg/d q8hr, max 1.5 g		**Daily doses of [[ceftriaxone]] and [[metronidazole]] just as effective:
	***Daily doses of [[ceftriaxone]] and [[metronidazole]] just as effective:		***[[Ceftriaxone]] 50 mg/kg, max 2 g QD '''AND'''
	****[[Ceftriaxone]] 50 mg/kg, max 2 g QD '''AND'''		***[[Metronidazole]] 30 mg/kg, max 1.5 g QD
	****[[Metronidazole]] 30 mg/kg, max 1.5 g QD

	===Surgery===		===Surgery===

Rossdonaldson1: /* Management */

2024-02-14T21:47:55Z

Management

← Older revision		Revision as of 21:47, 14 February 2024
Line 133:		Line 133:

	==Management==		==Management==
	*[[IVF]] (20 mL/kg boluses)		===Supportive Management===
	*[[Analgesia]]		*NPO status
	**[[~~Ketorolac~~]]		*[[Fluid resuscitation]]
	**[[~~Morphine~~]]		**[[IVF]] (20 mL/kg boluses)
			*[[Analgesia]]/[[antiemetics]] (e.g., [[morphine]], [[ondansetron]])

			===[[Antibiotics]]===
	*[[Antibiotics]]		*[[Antibiotics]]
	**[[Ampicillin/sulbactam]] '''OR''' [[cefoxitin]]		**[[Ampicillin/sulbactam]] '''OR''' [[cefoxitin]]
Line 150:		Line 153:
	****[[Ceftriaxone]] 50 mg/kg, max 2 g QD '''AND'''		****[[Ceftriaxone]] 50 mg/kg, max 2 g QD '''AND'''
	****[[Metronidazole]] 30 mg/kg, max 1.5 g QD		****[[Metronidazole]] 30 mg/kg, max 1.5 g QD

			===Surgery===
	*Surgical consult, NPO, surgical pre-op labs if appropriate		*Surgical consult, NPO, surgical pre-op labs if appropriate

Rossdonaldson1: /* Management */

2024-02-14T21:37:04Z

Management

← Older revision		Revision as of 21:37, 14 February 2024
Line 133:		Line 133:

	==Management==		==Management==
	*NPO
	*[[IVF]] (20 mL/kg boluses)		*[[IVF]] (20 mL/kg boluses)
	*[[Analgesia]]		*[[Analgesia]]
Line 151:		Line 150:
	****[[Ceftriaxone]] 50 mg/kg, max 2 g QD '''AND'''		****[[Ceftriaxone]] 50 mg/kg, max 2 g QD '''AND'''
	****[[Metronidazole]] 30 mg/kg, max 1.5 g QD		****[[Metronidazole]] 30 mg/kg, max 1.5 g QD
			*Surgical consult, NPO, surgical pre-op labs if appropriate

	==Disposition==		==Disposition==

← Older revision		Revision as of 09:31, 22 March 2026
Line 172:		Line 172:
	*CT with IV contrast		*CT with IV contrast
	**Sn: 94%, Sp: 95%		**Sn: 94%, Sp: 95%
	**Consider if ultrasound is equivocal ~~'''~~OR~~'''~~ strong suspicion despite normal ultrasound		**Consider if ultrasound is equivocal OR strong suspicion despite normal ultrasound


Line 201:		Line 201:

	<!--T:34-->		<!--T:34-->
	*[[Special:MyLanguage/Ampicillin/sulbactam\|Ampicillin/sulbactam]] ~~'''~~OR~~'''~~ [[Special:MyLanguage/cefoxitin\|cefoxitin]]		*[[Special:MyLanguage/Ampicillin/sulbactam\|Ampicillin/sulbactam]] OR [[Special:MyLanguage/cefoxitin\|cefoxitin]]
	*Penicillin allergy?		*Penicillin allergy?
	**[[Special:MyLanguage/Gentamicin\|Gentamicin]] + ([[Special:MyLanguage/clindamycin\|clindamycin]] ~~'''~~OR~~'''~~		**[[Special:MyLanguage/Gentamicin\|Gentamicin]] + ([[Special:MyLanguage/clindamycin\|clindamycin]] OR
	**[[Special:MyLanguage/metronidazole\|metronidazole]])		**[[Special:MyLanguage/metronidazole\|metronidazole]])
	*Perforation or complicated appendicitis<ref>Yardeni D et al. Single daily dosing [[Special:MyLanguage/ceftriaxone\|ceftriaxone]] and [[Special:MyLanguage/metronidazole\|metronidazole]] vs standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomized trial. J Pediatr Surg. 2008 Jun; 43(6): 981–985.</ref>		*Perforation or complicated appendicitis<ref>Yardeni D et al. Single daily dosing [[Special:MyLanguage/ceftriaxone\|ceftriaxone]] and [[Special:MyLanguage/metronidazole\|metronidazole]] vs standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomized trial. J Pediatr Surg. 2008 Jun; 43(6): 981–985.</ref>
	**IV antibiotic regimen as below:		**IV antibiotic regimen as below:
	***[[Special:MyLanguage/Ampicillin\|Ampicillin]] 100 mg/kg/d q6hr, max 8 g per dose ~~'''~~AND~~'''~~		***[[Special:MyLanguage/Ampicillin\|Ampicillin]] 100 mg/kg/d q6hr, max 8 g per dose AND
	***[[Special:MyLanguage/Gentamicin\|Gentamicin]] 5 mg/kg QD, max 300 mg ~~'''~~AND~~'''~~		***[[Special:MyLanguage/Gentamicin\|Gentamicin]] 5 mg/kg QD, max 300 mg AND
	***[[Special:MyLanguage/Metronidazole\|Metronidazole]] 30 mg/kg/d q8hr, max 1.5 g		***[[Special:MyLanguage/Metronidazole\|Metronidazole]] 30 mg/kg/d q8hr, max 1.5 g
	**Daily doses of [[Special:MyLanguage/ceftriaxone\|ceftriaxone]] and [[Special:MyLanguage/metronidazole\|metronidazole]] just as effective:		**Daily doses of [[Special:MyLanguage/ceftriaxone\|ceftriaxone]] and [[Special:MyLanguage/metronidazole\|metronidazole]] just as effective:
	***[[Special:MyLanguage/Ceftriaxone\|Ceftriaxone]] 50 mg/kg, max 2 g QD ~~'''~~AND~~'''~~		***[[Special:MyLanguage/Ceftriaxone\|Ceftriaxone]] 50 mg/kg, max 2 g QD AND
	***[[Special:MyLanguage/Metronidazole\|Metronidazole]] 30 mg/kg, max 1.5 g QD		***[[Special:MyLanguage/Metronidazole\|Metronidazole]] 30 mg/kg, max 1.5 g QD