Obligate signs of acute appendicitis in young children

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1. Obligate signs of acute appendicitis in young children

· Central abdominal pain moving to right iliac fossa

· Nausea, vomiting, anorexia

· Low-grade pyrexia

· Localised tenderness in right iliac fossa

· Right iliac fossa peritonism

· Percussion tenderness is a kinder sign of peritonism than rebound

· Rovsing's sign = pain in right iliac fossa on palpation of the left iliac fossa

2. What diseases should conduct a differential diagnosis of acute appendicitis at children of early age?

1) Pancreatitis
2) Pediatrics - Diabetic Ketoacidosis
3) Pediatrics -  Gastroenteritis
4) Ovarian Cysts Pediatrics - Henoch-Schönlein Purpura
5) Pediatrics - Intussusception
6) Pediatrics - Pneumonia
7) Pediatrics - Sickle Cell Disease
8) Pediatrics - Urinary Tract Infections and Pyelonephritis
9) Pelvic Inflammatory Disease
10) Ectopic Pregnancy
11) Renal Calculi
12) Testicular Torsion

3. Additional and special diagnostic methods for suspected acute appendicitis in young children?

· Observation of the child's interaction and gait prior to the examination can be extremely helpful

· A child with appendicitis typically prefers to lie still due to peritoneal irritation.

§ Observing the child's facial expression during palpation of the abdomen can be helpful in eliciting the location and intensity of any abdominal pain.

§ Localization of the pain depends on the position of the appendix.

§ Typically, maximal tenderness can be found at McBurney point in the right lower quadrant.

§ Rovsing sign is pain in the RLQ in response to left-sided palpation and strongly suggests peritoneal irritation

· The psoas sign is determined by placing the child on the left side and hyperextending the right leg.

· The obturator sign is determined by internal rotation of the flexed right thigh. Pain on movement may be caused by an inflammatory mass overlying the psoas muscle.

· The cough sign (sharp pain in the RLQ after a voluntary cough) is suggestive of peritoneal irritation.

· A rectal examination should be performed last and may reveal impacted stool, right-sided tenderness, or a mass. Be sure to perform a rectal examination (inspection, palpation, and digital examination) in children who have any abdominal tenderness, a history of constipation, a history of rectal bleeding, trauma, or suspected physical abuse.

Additional diagnosis include :

· Abdominal ultrasound : This imaging test uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. It is used to see internal organs as they work.

· CT scan : This imaging test uses both X-rays and computer technology to show detailed images of any part of the body. This includes the bones, muscles, fat, and organs. It is more detailed than a general X-ray.

· Blood tests : These tests check for infection and inflammation. They can also see if there are any problems with other abdominal organs, such as the liver or pancreas.

· Urine test : This test can tell if there is a bladder or kidney infection, which may have some of the same symptoms as appendicitis.

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