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Analgesia
Acute Appendicitis
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Gallstone Disease
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Acute Appendicitis
Last updated 14th May 2021
Presentation
- Central dull poorly localized abdominal pain -> migratory RIF sharp, constant and localized pain aggravated by movement and coughing
- Anorexia
- Nausea & vomiting – uncommon to have profuse vomiting, think gastroenteritis
- Mildly elevated temp (37.4-38), tachycardia
- Pelvic appendix may give symptoms of increased frequency and dysuria. Dipstick may reveal haematuria and proteinuria but urgent microscopy and Gram stain will not demonstrate bacteria
- McBurney’s point – maximal tenderness with guarding and rebound tenderness
Investigations
- IV access + Bloods
Routine – FBC, U&E, LFT, CRP, VBG
Blood cultures – if septic/ has temperature - Urine dip
- Urine pregnancy test/ serum HCG – for every female of reproductive age
- Erect CXR
- Radiological investigations depending on age and gender
Young males – clinical diagnosis
Females of reproductive age – US Abdo/Pelvis
CT Abdo/Pelvis
Management
- IV Antibiotics – based on local guidance
- IV Fluids
- Analgesia + antiemetics
- Surgical review – Appendicectomy or conservative management
Differential Diagnosis
- Meckel’s diverticulum
- Gynaecology – ectopic pregnancy, ovarian cyst torsion
- Renal colic
- Male – testicular torsion
- Gastroenteritis – Yersinia, Campylobacter jejuni