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APPENDICITIS IN
CHILDREN
LECTURE FROM PAEDIATRIC SURGERY DEPARTAMENT OF
VOLGOGRAD STATE MEDICAL UNIVERSITY
Pancreatitis
Pediatrics, Diabetic Ketoacidosis
Pediatrics, Gastroenteritis
Ovarian Cysts Pediatrics, Henoch-Schnlein Purpura
Pediatrics, Intussusception
Pediatrics, Pneumonia
Pediatrics, Sickle Cell Disease
Pediatrics, Urinary Tract Infections and Pyelonephritis
Pelvic Inflammatory Disease
Pregnancy, Ectopic
Renal Calculi
Testicular Torsion
Other Problems to be
Considered:
Lymphoma
Leukemia
Neurogenic appendicopathy
Paratubal cysts
Intentional injury
Sexual abuse
Typhilitis
Prehospital Care:
Emergency medical service (EMS) personnel are well-
trained and cognizant of how to assess and begin
treatment of the febrile, vomiting, child with abdominal
pain.
Intravenous fluid administration, pain management,
and antiemetic medication should be administered
based on local EMS protocols.
The EMS provider must gather accurate "QRST" data
including estimated fluid intake and loss, the child's
weight gain or loss, and home remedies and
interventions
Emergency Department
Care:
One of the difficult challenges in evaluating children
with abdominal pain is making a timely diagnosis prior
to appendiceal perforation. In the ED, classifying
patients with abdominal pain into the following 3
categories may be helpful:
Diagnosis not consistent with appendicitis
This group includes patients whose history and physical
examination are not consistent with appendicitis or any
significant abdominal process.
Importantly, a complete physical examination, including rectal
palpation and urinalysis, should be completed before
discharge from the ED.
Classic history for
appendicitis
Patients with a classic history for appendicitis require
prompt surgical consultation but may not require
emergency surgery. In fact, emergency appendectomy
(operation within 6 h) in children has no advantages
over urgent appendectomy (operation with 12 h) with
respect to gangrene and perforation rates,
readmissions, postoperative complications, hospital
stay, or hospital charges. This does not mean the
emergency physician who has made the diagnosis of
appendicitis will not contact the surgeon right away, but
the hospital admission and course must be discussed
with the surgeon, patient, and family
Antibiotic therapy
is an important aspect of the treatment of ruptured
appendicitis. Antibiotic therapy should be directed
against gram-negative and anaerobic organisms such
as Escherichia coli and Bacteroides species. The
administration of antibiotics, nasogastric tubes,
intravenous lines, urethral catheters, antiemetic
medicine, antipyretic medicine, and analgesia should
ideally be part of the ED protocol for managing the
preoperative child. Proponents of preoperative
antibiotic recommend that all children with appendicitis
receive gentamicin and clindamycin
Unclear diagnosis