Appendicitis

McBurney’s Point

It is a specific surface landmark on the right lower quadrant of the abdomen that corresponds to the base of the appendix.

RLQ at the Mcburney’s Point

• From the Right Anterior Superior Iliac Spine: About 1/3 the distance

• From the Umbilicus: About 2/3 the distance along the imaginary line connecting the umbilicus to the right ASIS.

Where is the location of the appendix?

Fecalith Obstruction in the Appendix > Mucus Build-up > Bacterial (E.coli) Proliferation > Ischemia (⬇O2) > Necrosis/Gangrene > Rupture > Peritonitis > Sepsis

What is the mechanism of Appendicitis? How does it start?

1. Vague umbilical pain that eventually moves to RLQ pain (Mcburney’s Point)

2. Fever, anorexia, nausea & vomiting

What is the usual assessment findings for people positive for Appendicitis?

WOF: sudden relief of pain (possible rupture)

What do we have to watch out for in patients positive for appendicitis?

Knee-Chest Position (guarding position)

What is the most comfortable position of patients with Appendicitis?

1. Blumberg’s Sign

2. Rovsing’s Sign

3. Psoas Sign

4. Obturator’s Sign

What physical examination is usually done for patients suspected of appendicitis?

Pain upon passive extension of the the Right Hip

What is a positive result of Psoas Sign?

Pain upon internal rotation of the Right Hip with a flexed Right Leg

What is a positive result for Obturator’s Sign?

Rebound Tenderness

What is another term for Blumberg’s Sign?

Patient feels pain when pressure is suddenly released from the abdomen than when it is pressed down.

What is a positive result of Blumberg’s Sign?

Pain is felt in the RLQ when palpating the LLQ

What is a positive result of Rovsing’s Sign?

1. Female: Pregnancy Test (to rule out ectopic pregnancy)

2. Ultrasound (children and pregnant women)

3. CT Scan (adults)

4. Laboratory (increase WBC, ESR, CRP)

What diagnostic tests are done to detect Appendicitis?

Goal: To prevent rupture

What is the goal when patient is positive for appendicitis?

STAT Appendectomy

• Laparoscopic (camera insertion)

• Laparotomy (opens the abdomen)

What is the priority management for patient’s with appendicitis?

1. NPO status

2. IV insertion

3. Antibiotic Prophylaxis

4. Analgesics (only given if appendicitis is confirmed; may mask the symptoms)

5. Avoid heating pads, laxatives, and enema

What is the preoperative management for patients with appendicitis?

NO

• only give when appendicitis is confirmed

Can we give analgesics to patients with suspected appendicitis?

Avoid heating pads, laxatives, enema

What things should be avoided by patients with appendicitis?

High-Fowler’s Position

• to reduce tension in the abdomen (decrease the risk of dehiscence)

• to promote lung expansion (prevent atelectasis)

What is the recommended position after laparotomy?