00:01
Our topic is pediatric appendicitis,
not adult.
00:05
Pediatric.
00:07
Most commonly caused by lymphoid
hyperplasia or perhaps fecalith.
00:12
What does that mean?
Think about the appendix
and know where you are.
00:16
Right lower quadrant.
00:18
What is an appendix?
It’s vestigial “organ”
and that at some point in time, it
behaves exactly like a diverticulum.
00:29
And so therefore, if you
have feces passing through
could it get stuck
in the appendix?
Sure, it can.
00:35
Welcome to fecalith.
00:37
And highlight or
keep in your head,
lymphoid hyperplasia being a major
cause of appendicitis in this child.
00:46
It may then cause
abdominal pain.
00:50
Here, signs and symptoms,
the child with this
pain is going to vomit.
00:56
Emesis, fever,
right lower quadrant
pain, peritoneal signs after 36 hours,
what does that mean to you?
Oh, my goodness,
there’s every possibility that the
appendicitis is going to rupture.
01:12
With this type of rupture
with an appendicitis,
what is it going to do?
You’re going to have a
massive WBC reaction.
01:21
What is this reaction
called, please?
Good.
01:24
Leukemoid reaction.
01:27
And your WBC count, why do
we call this leukemoid?
It looks like leukemia.
01:34
Your WBC count could be as high as 50,000.
01:39
What’s your normal WBC count?
4,500 to 11,000.
01:44
Do not forget about
peritoneal sign.
01:47
Diagnosis, look at some
differentials here.
01:49
Remember, a yersinia infection
-- do not forget this --
a yersinia infection, a gastroenteritis that behaves like appendicitis.
01:59
Remember, pseudo-appendicitis
with yersinia
and inflammatory bowel disease
is a possible differential.
02:07
Keep these in mind with
differential diagnoses.
02:14
Diagnosis itself,
CBC, appendicitis,
you find it be elevated.
02:19
Upon ultrasound,
what you’re seeing here is
thickening of the appendix,
that’s what the arrows
are pointing to.
02:26
Whereas the CT here,
remember where you are
remember how to interpret a CT?
The left side of this image is
the right side of the patient.
02:40
Your appendix located in
the right lower quadrant.
02:43
You’ll notice the white area
there which has become inflamed
and that is going to be
your appendicitis on CT.
02:52
Ultrasound, CT for
proper diagnosis.
02:57
Management:
Always worry about infection.
03:00
Antibiotics IV.
03:02
Surgery,
you need to get in there and remove
this before this thing ruptures.
03:07
Pediatric appendicitis,
lymphoid hyperplasia.