Appendicitis


Diagnosis

Pathophysiology

Treatment

  1. IVF, NPO, NGT if N/V
  2. Observation if Dx questionable
  3. Once Dx is definitive or strongly suspected: appendectomy
  4. Appendectomy with antibiotic treatment until the patient is afebrile and the WBC count normalizes.
  5. ADULTS:
  6. PEDIATRIC: 

Disposition

  1. Admit & immediate surg intervention for pts w/strong suspicion or definitive Dx
  2. Observe, either in ED or ward by surgical team if Dx suggested but weakly suspected

Admission Orders

1. Admit to:

2. Diagnosis: Appendicitis

3. Condition: Guarded.

4. Vital Signs: Routine

5. Activity:  Bedrest

6. Nursing: Inputs and outputs, daily weights; cooling measures prn temp >100.4 F. Age appropriate pain scale.

7. Diet: NPO

8. Isotonic fluids at maintenance rate.

9. Special Medications:

  • ADULTS:
    • uncomplicated acute appendicitis:
      -Given for 24 hours for uncomplicated appendicitis.
      -Cefoxitin : 1-2 g IV as a single dose before surgery, followed by 1-2 g every 8 hours for 2 doses post surgery
       
    • ill with perforation or abscess:
      -Cefoxitin : 1-2 g intravenously every 8 hours
      Ticarcillin/clavulanate : 3.1 g intravenously every 6 hours more
      Meropenem : 1 g intravenously every 8 hours
      Cefotaxime : 1-2 g intravenously every 8 hours or
      Ceftriaxone : 1-2 g intravenously every 24 hours
      -- AND --
      Aztreonam : 1-2 g intravenously every 8-12 hours
      -gentamicin : 5-7 mg/kg/day intravenously
      -- AND --
      Clindamycin : 300-900 mg intravenously every 6-12 hours or
      -Metronidazole : 500 mg intravenously every 8 hours
       
  • PEDIATRIC:
    • Cefotetan 40mg/kg IV q12h
    • Cefoxitin 40mg/kg IV q6h
    • Gentamicin 2.5mg/kg IV q8h PLUS
      • Clindamycin 10mg/kg IV q8h
        OR
      • Metronidazole 7.5mg/kg IV q6h

10. Symptomatic Medications: .

-Ibuprofen 5-10 mg/kg/dose PO q6-8h prn OR

-Acetaminophen 15 mg/kg PO/PR q4h prn temp > 100.4 F or pain.
 

11. Extras and X-rays: 
  - CXR PA, LAT, ECG Abdominal ultrasound, abdominal x-ray series,
  - HCG in women, CT Abdomen in non-preg, MRI in preg (+), UA .
 

12. Labs: 
  - CBC, CMP, blood culture and sensitivity, antibiotic levels.