Appendicitis (peds): Difference between revisions
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== Laboratory Findings == | == Laboratory Findings == | ||
*WBC | *WBC | ||
** | **<10K is strong negative predictor for appy | ||
*UA | *UA | ||
**7-25% of pts with appy have sterile pyuria | **7-25% of pts with appy have sterile pyuria | ||
== Imaging == | == Imaging == | ||
*Consider only in intermediate-risk pts | *Consider only in intermediate-risk pts | ||
*Ultrasound | *Ultrasound | ||
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== Pediatric Appendicitis Score == | == Pediatric Appendicitis Score == | ||
*Anorexia - 1pt | *Anorexia - 1pt | ||
*Nausea or vomiting - 1pt | *Nausea or vomiting - 1pt | ||
| Line 74: | Line 68: | ||
*WBC > 10K - 1pt | *WBC > 10K - 1pt | ||
*Neutrophils + bands > 7500- 1pt | *Neutrophils + bands > 7500- 1pt | ||
*Score ≤ 2 | *Score ≤ 2 | ||
**Low risk (0-2.5%) | **Low risk (0-2.5%) | ||
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== Management == | == Management == | ||
*IVF (20 mL/kg boluses) | |||
* | |||
*Analgesia | *Analgesia | ||
*ABx | *ABx | ||
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== Differential Diagnosis == | == Differential Diagnosis == | ||
*Emergent surgical diagnoses | *Emergent surgical diagnoses | ||
**Bowel obstruction | **Bowel obstruction | ||
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**Gastroenteritis (esp yersinia) | **Gastroenteritis (esp yersinia) | ||
== See Also == | ==See Also== | ||
[[Abdominal Pain (Peds)]] | |||
== Source == | |||
UpToDate, Tintinalli | |||
[[Category:Peds]] | |||
[[Category:GI]] | |||
Revision as of 23:11, 22 June 2011
Background
- Most common between 9-12yr
- Perforation rate 90% in children <4yr
- NPV of 98% achieved if:
- Lack of nausea (or emesis or anorexia)
- Lack of maximal TTP in the RLQ
- Lack of neutrophil count > 6750
Diagnosis
- Local tenderness + McBurney's point rigidity most reliable clinical sign
Neonates
- History
- Vomiting
- Irritability/lethargy
- Physical
- Abdominal distention
Infants (30 days - 2 yrs)
- History
- Vomiting
- Abdominal pain
- Fever
- Physical
- Diffuse abdominal tenderness
- Localized RLQ TTP occurs <50%
- Diffuse abdominal tenderness
Preschool (2 - 5yrs)
- History
- Vomiting (often precedes pain)
- Abdominal pain
- Fever
- Physical
- RLQ tenderness
School-age (6 - 12yrs)
- History
- Vomiting
- Abdominal pain
- Fever
- Physical
- RLQ tenderness
Adolescents (>12yrs)
- Present similar to adults
- RLQ pain
- Vomiting (occurs after onset of abdominal pain)
- Anorexia
Laboratory Findings
- WBC
- <10K is strong negative predictor for appy
- UA
- 7-25% of pts with appy have sterile pyuria
Imaging
- Consider only in intermediate-risk pts
- Ultrasound
- Sn: 88%, Sp: 94%
- Consider as 1st choice in non-obese children
- CT (+/- contrast)
- Sn: 94%, Sp: 95%
- Consider if U/S is equivocal OR strong suspicion despite normal U/S
Pediatric Appendicitis Score
- Anorexia - 1pt
- Nausea or vomiting - 1pt
- Migration of pain - 1pt
- Fever > 100.5 - 1pt
- Pain with cough, percussion, or hopping - 2pt
- RLQ tenderness - 2pt
- WBC > 10K - 1pt
- Neutrophils + bands > 7500- 1pt
- Score ≤ 2
- Low risk (0-2.5%)
- Consider d/c home with close f/u
- Score ≥ 7
- High risk
- Consider surgical consultation
- Score 3-6
- Indeterminate risk
- Consider serial exams, consultation, or imaging
Management
- IVF (20 mL/kg boluses)
- Analgesia
- ABx
- Second gen cephalosporin OR
- Piperacillin/tazobactam OR
- Penicillin allergy?
- Gent + (clinda or metronidazole)
Differential Diagnosis
- Emergent surgical diagnoses
- Bowel obstruction
- Malrotation
- Intussusception
- Ovarian torsion
- Ectopic pregnancy
- Emergent nonsurgical diagnoses
- HUS
- DKA
- Non-emergent diagnoses
- PID
- PNA
- UTI
- Strep throat
- Gastroenteritis (esp yersinia)
See Also
Source
UpToDate, Tintinalli