Appendicitis AAFP Rakel
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Questions and Answers

Which of the following signs and symptoms provides the best evidence for ruling in acute appendicitis in adults?

  • Diarrhea
  • Fever below 37.0°C
  • Nausea and vomiting
  • Right lower quadrant pain (correct)

    • What is the main complication associated with acute appendicitis that can lead to severe outcomes?

  • Abscess formation
  • Bowel obstruction
  • Sepsis
  • Perforation (correct)

    • In the pediatric appendicitis score, how is the right lower quadrant pain evaluated?

  • By observing for rebound tenderness
  • By measuring leukocytosis
  • By assessing for cough tenderness (correct)
  • By checking for bowel sounds

    • What score range indicates a moderate risk of appendicitis according to the Alvarado score?

    <p>4 to 6</p> Signup and view all the answers

    Which sign indicates positive psoas sign during an examination for acute appendicitis?

    <p>Pain on passive extension of the thigh</p> Signup and view all the answers

    The Appendicitis Inflammatory Response Score includes which of the following components?

    <p>C-reactive protein</p> Signup and view all the answers

    What element is NOT part of the Alvarado score used for diagnosing appendicitis?

    <p>Weight gain</p> Signup and view all the answers

    What is indicated by a leukocytosis level of 10,000 per μL or more in the context of appendicitis?

    <p>Moderate risk of appendicitis</p> Signup and view all the answers

    What is the McBurney Point?

    <p>Point two thirds the distance from the umbilicus to the anterosuperior iliac spine</p> Signup and view all the answers

    Which sign indicates tenderness referred from the left lower quadrant to the right lower quadrant during palpation?

    <p>Rovsing sign</p> Signup and view all the answers

    What is the psoas sign and how is it elicited?

    <p>Pain on passive extension of the right thigh with the patient lying on the left side</p> Signup and view all the answers

    Which sign is defined as pain elicited by abducting the right hip while the patient is lying supine?

    <p>Obturator sign</p> Signup and view all the answers

    Which clinical signs are most reliable for ruling in acute appendicitis in children?

    <p>Positive psoas sign and decreased bowel sounds</p> Signup and view all the answers

    What does the Appendicitis Inflammatory Response include?

    <p>Inflammatory biomarker CRP and severity levels for various signs</p> Signup and view all the answers

    How many total criteria are in the Alvarado scoring system?

    <p>8</p> Signup and view all the answers

    In which groups are patients more likely to undergo CT initially because ultrasonography may be nondiagnostic?

    <p>Overweight and obese patients</p> Signup and view all the answers

    Which criteria is specifically linked to a higher score in the Alvarado score for diagnosing appendicitis?

    <p>Rebound pain</p> Signup and view all the answers

    Which factor is a definitive complication of acute appendicitis?

    <p>Abscess formation</p> Signup and view all the answers

    What symptom would likely increase the Pediatric Appendicitis Score?

    <p>Right lower quadrant tenderness</p> Signup and view all the answers

    What is an essential biomarker included in the Appendicitis Inflammatory Response Score?

    <p>C-reactive protein</p> Signup and view all the answers

    Which risk category does a score of 5 on the Alvarado score indicate?

    <p>Moderate risk</p> Signup and view all the answers

    Which clinical finding is associated with appendicitis in children but not commonly observed in adults?

    <p>Positive obturator sign</p> Signup and view all the answers

    What does a constant temperature ≥ 37.3°C indicate in the context of appendicitis?

    <p>Inflammatory response</p> Signup and view all the answers

    Which physical examination technique is used to assess for pain in response to passive extension of the right thigh?

    <p>Positive psoas sign</p> Signup and view all the answers

    What does a positive Rovsing sign indicate during an abdominal examination?

    <p>Pain in the left lower quadrant when the right lower quadrant is palpated</p> Signup and view all the answers

    Which of the following best describes the obturator sign?

    <p>Pain experienced upon passive internal rotation of a flexed thigh</p> Signup and view all the answers

    What is the main feature of the Appendicitis Inflammatory Response compared to other scoring systems?

    <p>It utilizes an inflammatory biomarker.</p> Signup and view all the answers

    Which criteria are assessed in the Alvarado scoring system?

    <p>Severity levels of rebound pain and polymorphonucleocytes</p> Signup and view all the answers

    How is the psoas sign effectively elicited during a physical exam?

    <p>By extending the right thigh with counter resistance while the patient lies on their left side</p> Signup and view all the answers

    Which patient demographic is more likely to undergo CT scans for appendicitis diagnosis due to nondiagnostic ultrasonography?

    <p>Overweight and obese patients</p> Signup and view all the answers

    How many total criteria does the Alvarado scoring system consist of?

    <p>8</p> Signup and view all the answers

    Where is the McBurney point located?

    <p>Two-thirds the distance from the umbilicus to the iliac spine</p> Signup and view all the answers

    Study Notes

    McBurney Point

    • Located two-thirds the distance from the umbilicus to the anterosuperior iliac spine.

    Key Signs in Appendicitis

    • Rovsing Sign: Referred tenderness from the left lower quadrant (LLQ) to the right lower quadrant (RLQ) during palpation.
    • Psoas Sign: Pain elicited by extending the hip when the patient lies prone.
    • Obturator Sign: Pain elicited by abducting the right hip with the patient in a supine position.

    Diagnostic Signs for Appendicitis

    • Signs that reliably indicate acute appendicitis in children include:
      • Absent or decreased bowel sounds.
      • Positive psoas, obturator, and Rovsing signs.

    Appendicitis Inflammatory Response

    • Fewer symptoms compared to the Alvarado score and Pediatric Appendicitis Score.
    • Incorporates C-reactive protein (CRP) as an inflammatory biomarker.
    • Assesses severity of rebound pain, leukocytosis, and polymorphonuclear cells.

    Eliciting Signs

    • Psoas Sign: Pain occurs on passive extension of the right thigh while the patient lies on the left side.
    • Obturator Sign: Pain occurs on passive internal rotation of the flexed thigh.

    Demographics and Imaging

    • Overweight and obese individuals are more likely to undergo CT scans due to nondiagnostic results from ultrasonography.

    Alvarado Score Criteria

    • Total criteria include 8 indicators, scoring as follows:
      • Migration of pain (1)
      • Anorexia (1)
      • Nausea/vomiting (1)
      • Right lower quadrant tenderness (2)
      • Rebound pain (1)
      • Temperature ≥ 37.3°C (99.1°F) (1)
      • Leukocytosis ≥ 10,000 per µL (2)
      • PMN ≥ 75% (1)
    • Possible total score is 10.

    Pediatric Appendicitis Score

    • Adds an assessment for right lower quadrant pain during coughing, hopping, or percussion.

    Risk Scoring System

    • Alvarado score risk categories:
      • High risk: score ≥ 7
      • Moderate risk: score 4 to 6
      • Low risk: score < 4

    Complications of Appendicitis

    • Most concerning complication is perforation, which can lead to abscesses, peritonitis, bowel obstruction, fertility issues, and sepsis.

    Signs and Symptoms in Appendicitis

    • In Adults:
      • Right lower quadrant pain.
      • Abdominal rigidity.
      • Radiation of periumbilical pain to RLQ.
    • In Children:
      • Absent or decreased bowel sounds.
      • Positive psoas, obturator, and Rovsing signs.

    Evaluation Tools

    • Adults: Alvarado score.
    • Pediatrics: Pediatric Appendicitis score.

    Summary of Alvarado Score Components

    • M: Migration of pain (1)
    • A: Anorexia (1)
    • N: Nausea (1)
    • T: Right lower quadrant tenderness (2)
    • R: Rebound pain (1)
    • E: Elevated temperature (1)
    • L: Leukocytosis (2)
    • S: Shift to the left (1)

    McBurney Point

    • Located two-thirds the distance from the umbilicus to the anterosuperior iliac spine.

    Key Signs in Appendicitis

    • Rovsing Sign: Referred tenderness from the left lower quadrant (LLQ) to the right lower quadrant (RLQ) during palpation.
    • Psoas Sign: Pain elicited by extending the hip when the patient lies prone.
    • Obturator Sign: Pain elicited by abducting the right hip with the patient in a supine position.

    Diagnostic Signs for Appendicitis

    • Signs that reliably indicate acute appendicitis in children include:
      • Absent or decreased bowel sounds.
      • Positive psoas, obturator, and Rovsing signs.

    Appendicitis Inflammatory Response

    • Fewer symptoms compared to the Alvarado score and Pediatric Appendicitis Score.
    • Incorporates C-reactive protein (CRP) as an inflammatory biomarker.
    • Assesses severity of rebound pain, leukocytosis, and polymorphonuclear cells.

    Eliciting Signs

    • Psoas Sign: Pain occurs on passive extension of the right thigh while the patient lies on the left side.
    • Obturator Sign: Pain occurs on passive internal rotation of the flexed thigh.

    Demographics and Imaging

    • Overweight and obese individuals are more likely to undergo CT scans due to nondiagnostic results from ultrasonography.

    Alvarado Score Criteria

    • Total criteria include 8 indicators, scoring as follows:
      • Migration of pain (1)
      • Anorexia (1)
      • Nausea/vomiting (1)
      • Right lower quadrant tenderness (2)
      • Rebound pain (1)
      • Temperature ≥ 37.3°C (99.1°F) (1)
      • Leukocytosis ≥ 10,000 per µL (2)
      • PMN ≥ 75% (1)
    • Possible total score is 10.

    Pediatric Appendicitis Score

    • Adds an assessment for right lower quadrant pain during coughing, hopping, or percussion.

    Risk Scoring System

    • Alvarado score risk categories:
      • High risk: score ≥ 7
      • Moderate risk: score 4 to 6
      • Low risk: score < 4

    Complications of Appendicitis

    • Most concerning complication is perforation, which can lead to abscesses, peritonitis, bowel obstruction, fertility issues, and sepsis.

    Signs and Symptoms in Appendicitis

    • In Adults:
      • Right lower quadrant pain.
      • Abdominal rigidity.
      • Radiation of periumbilical pain to RLQ.
    • In Children:
      • Absent or decreased bowel sounds.
      • Positive psoas, obturator, and Rovsing signs.

    Evaluation Tools

    • Adults: Alvarado score.
    • Pediatrics: Pediatric Appendicitis score.

    Summary of Alvarado Score Components

    • M: Migration of pain (1)
    • A: Anorexia (1)
    • N: Nausea (1)
    • T: Right lower quadrant tenderness (2)
    • R: Rebound pain (1)
    • E: Elevated temperature (1)
    • L: Leukocytosis (2)
    • S: Shift to the left (1)

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    Description

    This quiz focuses on the Pediatric Appendicitis Score, assessing the criteria used for diagnosing appendicitis in children. It covers symptoms like right lower quadrant tenderness, vomiting, and lab findings such as leukocytosis. Test your knowledge about scoring methods and their implications in clinical practice.

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