Appendicitis

[size=6]You are asked to assess a 12-year-old child with appendicitis. The appendix is 10mm in diameter on CT with no fecalith. There is a low-grade fever and the WBC = 13,000/uL. After 12 hours of IV ceftriaxone and metronidazole the pain has improved. The patient and their parents have expressed a strong desire to avoid surgical intervention. They confirm adequate access to follow up care. What of the following is the most appropriate management? a IV antibiotics for 48 hours then discharge home on 7 days of PO cefdinir/metronidazole b Discharge on PO cipro/metronidazole for 14 days c IV antibiotics until afebrile and a normal WBC then discharge home with no fu…

[size=6]A 6 year-old presented with 10-days of symptoms and perforated appendicitis with abscess. They underwent IR percutaneous drainage of abscess. Five days later, they are clinically improved with 20 mL/d brownish fluid out of the drain. A drain study was obtained. What is the best next step in this patient’s management? a Clamp drain b Continue drain to gravity c Place a second drain d Diagnostic laparoscopy e Remove drain[/size]

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A 4-year old boy presents with 6 days of abdominal pain and vomiting. On exam, he appears ill with a heart rate of 130 and temp of 39.3 C. His abdomen is distended and diffusely tender. Abdominal series shown (look carefully!). Diagnosis?

[size=20px]A 12-year-old girl presents with acute appendicitis. She undergoes an uneventful laparoscopic appendectomy. Pathologic review reveals a 1 cm carcinoid/neuroendocrine tumor at the base of the appendix with perineural invasion but no evidence of lymphatic or vascular invasion. One lymph node was included in the specimen and was negative for tumor. What is the best next step in the management of this patient? A Octreotide scan B Observation alone C Right Hemicolectomy D Ileocecectomy E MRI of the abdomen[/size]

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[size=20px]A fourteen-year-old girl presents to the Emergency Room for evaluation for appendicitis. You tell her parents that you would like the child to have an ultrasound to aid in the diagnosis, but her father states that he would prefer that you save time and proceed straight to a CT scan. What information would you pass along to parents regarding the risks of cancer associated with the use of CT in children? A There is an increased risk for developing leukemia. B Cancers associated with CT scans occur late in life. C There is increased risk for developing abdominopelvic tumors. D There is no cancer risk associated with CT scans in children. [/size]

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a pediatrician consults you on a 10 year old boy hospitalized for 5 days for abdominal pain and fever. Exam shows a sick child with diffuse peritonitis. Abdominal films are shown. What is the most likely diagnosis and how would you manage him?

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[size=20px]A 10 year old girl presents with acute onset of right sided abdominal pain. A normal appendix is found during diagnostic laparoscopy, and the ovaries and terminal ileum appear normal. Which of the following should also be examined before finishing the operation? A spleen B transverse colon C omentum D kidney E rectum [/size]

[center]by prof Amin El-Gohary appendicitis 2023.pdf ​[/center]

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