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Thursday, 5 December 2013

Appendicitis: The Signs and Symptoms

Appendicitis is defined as a condition of inflammation of Appendix. It is classified as an emergency, in many required the removal of the appendix. If burst, or perforate, spilling infectious materials into the abdominal cavity can be life threatening.
I. Signs and Symptoms
1. Abdominal pain and upper respiratory tract infection
Although appendicitis is the condition that most commonly requires emergent abdominal surgery in the paediatric population, less than 2% of the disease occurs in infants and it is even more uncommon in neonates. There is report of a rare case of a 14-month-old child presenting with abdominal pain first diagnosed with upper respiratory tract infection and then admitted to our Paediatric Surgery Department with a final diagnosis of acute appendicitis, according to the FONDAZIONE IRCCS CA’ GRANDA – Ospedale Maggiore Policlinico(1).
2. Vomiting,fever, pain, anorexia, diarrhea, abdominal tenderness, peritonitis, temperature 38.0 degrees C or more, abdominal distension, Leukocytosis, small-bowel obstruction (SBO), Contrast enemas and Perforated appendicitis
In the study to identify the presenting symptoms and signs in this age group and examine their subsequent management and outcome, by the The Scarborough Hospital, indicated that in 27 children less than 3 years old (mean 23 months) comprised 2.3% of all children with appendicitis in the series, the most common presenting symptoms were vomiting (27), fever (23), pain (21), anorexia (15), and diarrhea (11). The average duration of symptoms was 3 days, with 4 or more days in 9 children. Eighteen children were seen by a physician before the correct diagnosis was made; 14 were initially treated for an upper respiratory tract infection, otitis media, or a urinary tract infection. The most common presenting signs were abdominal tenderness (27), peritonitis (24), temperature 38.0 degrees C or more (21), abdominal distension (18), Leukocytosis (<12.0 x 10(3)/mm(3)) was found in 18, tenderness was localized to the right lower quadrant (RLQ) in 14 and was diffuse in 10. Abdominal radiographs demonstrated findings of a small-bowel obstruction (SBO) in 14 of 21 patients, a fecalith in 2, and a pneumoperitoneum in 1. Contrast enemas were performed in 6 children, 5 of whom had a phlegmon or an abscess. Perforated appendicitis was found in all 27 patients. An appendectomy was performed in 25 and a RLQ drain was placed in 18(2).
3. An abdominal mass, guarding, rebound tenderness, rigidity, diffuse or focal tenderness, diarrhea, emesis, fever, pain, and anorexia
According to the Children's Hospital of Philadelphia, the common physical signs of an abdominal mass, guarding, rebound tenderness, rigidity, and diffuse or focal tenderness and common symptoms are diarrhea, emesis, fever, pain, and anorexia with the most common presenting symptom was abdominal pain (94%); the most common sign was abdominal tenderness (95.8%)(3)
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22878766
(2) http://www.ncbi.nlm.nih.gov/pubmed/14730382
(3) http://www.ncbi.nlm.nih.gov/pubmed/10888451