Appendicitis (peds): Difference between revisions
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== Management == | == Management == | ||
*NPO | |||
*IVF (20 mL/kg boluses) | *IVF (20 mL/kg boluses) | ||
*Analgesia | *Analgesia | ||
*ABx | *ABx | ||
** | **Ampicillin/sulbactam OR | ||
** | **Cefoxitin | ||
**Penicillin allergy? | **Penicillin allergy? | ||
***Gent + (clinda or metronidazole) | ***Gent + (clinda or metronidazole) | ||
**Perforation? | |||
***Piperacillin/tazobactam | |||
** | |||
* | |||
** | |||
==See Also== | ==See Also== | ||
Revision as of 23:14, 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
- NPO
- IVF (20 mL/kg boluses)
- Analgesia
- ABx
- Ampicillin/sulbactam OR
- Cefoxitin
- Penicillin allergy?
- Gent + (clinda or metronidazole)
- Perforation?
- Piperacillin/tazobactam
See Also
Source
UpToDate, Tintinalli