Appendicitis - Eastern Kentucky Universityappendicitis Rovsing’sSign Rovsing’sSign : If...
Transcript of Appendicitis - Eastern Kentucky Universityappendicitis Rovsing’sSign Rovsing’sSign : If...
3/13/2015
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AppendicitisBROOKE BENTLEY, PHD, APRN
Appendicitis
Appendix = small, fingerlike appendage (4 inches) attached to cecum; fills with food and empties into cecum; small lumen; prone to obstruction and infection
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Etiology
� Obstruction is commonly caused by
a fecalith
Incidence & Demographics
� Most common in people age 10-30 with peak incidence at 15-24
� In patients >50 yo and <5 yo, classic symptoms less frequent, although
perforation is more common, with a higher mortality & morbidity
� A ruptured appendix occurs in one half of children under 6 yo with
appendicitis
� Most common cause of abdominal pain requiring surgery in childhood &
adolescence
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History
� Pain begins gradually; starts as vague, colicky, cramping, and
poorly localized to the periumbilical or epigastric area
� Later becomes localized to the right lower quadrant (RLQ)
� Anorexia, abdominal pain, nausea and vomiting are most
common symptoms (in this order)
Physical Exam
� Fever usually 99-101 degrees F
� Patients frequently flex the right lower extremity when supine to relieve
muscle tension
� May have decreased bowel sounds
� Maximum abdominal tenderness & rigidity occurs over the right rectus
muscle (McBurney’s point)
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McBurney’s Point
Psoas Sign� Psoas Sign involves:
� 1. placing patient in supine position and putting pressure on the right leg
above the knee while the patient attempts to move his or her right hip against
the pressure OR
� 2. placing patient in left lateral position and extending the patient’s right leg
at the hip
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Obturator Sign
� Obturator Sign: the internal rotation of the right leg with the leg flexed to
90 degrees at the hip and knee and a resultant tightening of the internal
obturator muscle may cause abdominal discomfort indicative of
appendicitis
Rovsing’s Sign
� Rovsing’s Sign: If palpation of the left lower quadrant of a person's
abdomen increases the pain felt in the right lower quadrant, the patient is
said to have a positive Rovsing's sign and may have appendicitis
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Rebound Tenderness
� Rebound tenderness: increase in pain when the pressure is released
Markle Test (Heel Jar)
� raise heels & drop suddenly OR jump in place
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Physical Exam
� A pelvic exam on all females with lower abdominal pain to rule
out pelvic inflammatory disease (PID), adnexal mass, ectopic
pregnancy, or uterine pathology
Other Differential Diagnoses
� Ectopic pregnancy
� Pelvic inflammatory disease
� Testicular
� Gastroenteritis
� Urinary tract infection
� Inflammatory bowel disease
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Diagnostics
� 1. If thinking acute abdomen: appendicitis
�Consult with surgeon
� 2. If NOT acute abdomen:
�Other diagnostics based on differential diagnoses