Pediatric Appendicitis

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.