✅مبحث آپاندیسیت حاد
یکی از شکایت‌های شایع اورژانس و از تشخیص افتراقی‌های شکم حاد، که بد نیست مروری داشته باشیم به منجمنت اولیه و تا وقتی که بیمار به دست سرویس جراحی جهت تصمیم گیری براش برسه. درباره آنتی بیوتیک تراپی و اینکه حتما باید جراحی بشه؟ و...

یکی دو جمله هم داشته باشیم:

▪︎Appendicitis is one of the most common causes of the acute abdomen and one of the most frequent indications for an emergency abdominal surgical procedure worldwide.

▪︎Appendicitis is suspected in patients who present acutely with right lower quadrant pain/tenderness and leukocytosis but only confirmed on histologic finding of a surgical specimen.

▪︎most frequently in the second and third decades of life. The incidence is highest in the 10-to-19-year-old age group and lowest in children ≤9 years.

➡️Acute appendicitis in adults

📝 ED order for suspected appendicitis
#Order

▪︎Imp: Appendicitis
▪︎Cond: Emergency
▪︎Diet: NPO
▪︎Act: CBR and bed sides up

▪︎CVS

▪︎IV line fix
*IV fluid therapy with N.S as needed(0.5-1L bolus then 100cc/h)

▪︎CM and POM
*O2 therapy if sat<90%

▪︎Check CBC, Chemistry, LFTs + lipase, coagulation studies (PT, PTT, INR), Urine pregnancy, Urinalysis,CRP.
* no WBC count or CRP level can safely and sufficiently confirm or exclude the suspected diagnosis of acute appendicitis.

▪︎Abd Pelvic CT w/w.o  IV contrast (if available):gold STD

*CT demonstrates higher diagnostic accuracy than ultrasound or MRI.
🔺️avoid CT in pregnancy
🔺️Relative contraindications to contrast are :
*Renal insufficiency (estimated glomerular filtration rate [eGFR] <30 mL/minute per 1.73 m2)
*History of hypersensitivity reaction to iodinated contrast

▫️Abdominal ultrasound in pregnant women or if CT isn’t available.

*A positive ultrasound result indicates that treatment for appendicitis should be initiated, whereas a negative result indicates that a normal appendix has been visualized and appendicitis is highly unlikely as the diagnosis.
🔺️Importantly, unlike CT or MRI, a nondiagnostic ultrasound result does not have a high negative predictive value for appendicitis, and continued imaging evaluation is warranted(if clinical suspicion is high)

▪︎Amp ondansetron IV or IM 4-8mg may repeated q4-8h, (max 24mg a day) as necessary based on n/v

▪︎Amp acetaminophen 1g IV q6h as needed for pain
or
▫️Amp morphine 1-4mg IV q1-4h as needed in severe pain
*Opiate analgesia does not limit abdominal examination for a potential surgical condition.

▪︎Amp ceftriaxone 2g IV once daily

▪︎Amp metronidazole 500mg IV q8h

▪︎Surgical consultation


Appendix:

▪︎In non-perforated appendicitis based on CT, we should appendectomy if:
Diffuse peritonitis,
Hemodynamically instability,
Severe sepsis,
Pregnancy,
immunocompromise, or
history of inflammatory bowel disease is present.