Appendicitis (peds): Difference between revisions
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**Lack of neutrophil count > 6750 | **Lack of neutrophil count > 6750 | ||
== | == Clinical Features== | ||
*Local tenderness + McBurney's point rigidity most reliable clinical sign | *Local tenderness + McBurney's point rigidity most reliable clinical sign | ||
===Neonates=== | ===Neonates=== | ||
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**Anorexia | **Anorexia | ||
== | ==Diagnosis== | ||
=== Pediatric Appendicitis Score === | |||
= | |||
== Pediatric Appendicitis Score == | |||
*Anorexia - 1pt | *Anorexia - 1pt | ||
*Nausea or vomiting - 1pt | *Nausea or vomiting - 1pt | ||
| Line 79: | Line 65: | ||
**Indeterminate risk | **Indeterminate risk | ||
**Consider serial exams, consultation, or imaging | **Consider serial exams, consultation, or imaging | ||
=== 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 | |||
== Management == | == Management == | ||
| Line 85: | Line 86: | ||
*Analgesia | *Analgesia | ||
*ABx | *ABx | ||
**Ampicillin/sulbactam OR | **Ampicillin/sulbactam OR cefoxitin | ||
**Penicillin allergy? | **Penicillin allergy? | ||
***Gent + ( | ***Gent + (clindamycin or metronidazole) | ||
**Perforation? | **Perforation? | ||
***Piperacillin/tazobactam | ***Piperacillin/tazobactam | ||
Revision as of 08:10, 18 April 2012
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
Clinical Features
- 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
Diagnosis
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
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
Management
- NPO
- IVF (20 mL/kg boluses)
- Analgesia
- ABx
- Ampicillin/sulbactam OR cefoxitin
- Penicillin allergy?
- Gent + (clindamycin or metronidazole)
- Perforation?
- Piperacillin/tazobactam
See Also
Source
- UpToDate
- Tintinalli