In this post, I link to and excerpt from The Cribsiders’ [link is to the complete episode list] #49: Appendicitis – Tips and Tricks For When It’s the Appendix. APRIL 27, 2022 By DR SAM MASUR.
All that follows is from the above outstanding resource.
Does abdominal pain give you abdominal pain? Not to worry, Dr. Alex Hirsch, pediatric emergency medicine physician, and Dr. Prathima Nandivada, pediatric surgeon extraordinaire, are here to remind us what the appendix is, what happens when it goes wrong, how to manage it, and more in this gut-wrenching episode.
- While textbooks teach that right lower quadrant pain, anorexia, and pain with coughing/jumping are the classic presentation of appendicitis, presentations can also mimic gastroenteritis, constipation, and UTI, so have a low threshold to keep appendicitis on your differential for pediatric patients with abdominal pain, as appendicitis is a must-not-miss diagnosis (especially in those tricky toddlers!).
- Validated scoring systems like the Pediatric Appendicitis Score (great for bedside use) and the Pediatric Appendicitis Risk Calculator (more accurate, but cannot be done at the bedside) are important tools to help risk-stratify patients.
- In settings with experienced sonographers, ultrasound is a great first step to evaluate for signs of appendicitis or secondary signs of inflammation, but cross-sectional imaging (CT or MRI) may be needed to further confirm/evaluate.
- Appendectomy is the treatment of choice for acute uncomplicated appendicitis. Non-operative management with antibiotics may have up to a 20% failure rate and requires a reliable, well-informed family and shared decision making. Appendicolith and major appendix dilation are contraindications to non-operative management.
- There are racial disparities in the management of appendicitis. Minority children are more likely to be diagnosed with perforated appendicitis, less likely to undergo a laparoscopic procedures, and less likely to receive opioid pain medications.