Appendicitis

History

Vague nonspecific abdominal cramping and nausea (Nonspecific Phase) gradually progresses to localized pain (Localized Phase). The pain most commonly localizes in the RIGHT LOWER QUADRANT near McBurney’s Point.

Exam

* Focal tenderness in the right lower quadrant* McBurney’s Point: 1/3 the distance traveled from anterior superior iliac spine (ASIS) to the navel. * Psoas Sign: Pain with hyperextension of the right hip (while patient is laying on left side)* Obturator Sign: Pain when flexing right hip to 90 degrees and rotating* Rovsing Sign: Pain felt in the right lower quadrant when pushing on the left lower quadrant

Testing

Fact 1: The urinalysis can be abnormal in appendicitis

Fact 2: The white blood cell count can be normal in appendicitis

As far as imaging when appendicitis is suspected…

* Most people get a CT scan * Most pregnant women get MRI * Most pediatric patients get an ultrasound

Treatment

* Analgesia (example- 4mg IV morphine)* Antiemetics (example- 4mg IV ondansetron… aka Zofran)* Antibiotics (example- 4.5mg IV piperacillin/tazobactam.. aka Zosyn aka “pip-tazo”)

Diverticulitis

History

Similar to appendicitis. Vague nonspecific cramping and nausea gradually progressing to localized pain. This pain most commonly is located in the LEFT LOWER QUADRANT. Stool related complaints such as constipation and bleeding also common

Exam

Tenderness in the left lower quadrant

Testing

Easy… Get a CT scan

Treatment

If the patient has severe symptoms, big risk factors such as immunosuppression, or complications of diverticulitis (abscess, perforations, etc). Treat the same as appendicitis… Admit, antibiotics, surgery consult

If the patient has mild symptoms, they commonly are sent home on oral antibiotics and close follow up.

Additional Reading

* American college of radiology imaging options for appendicitis (ACR)* American college of radiology imaging options for diverticulitis (ACR)