⚡ Chapter 391: Acute Appendicitis

Nelson Textbook of Pediatrics 22nd Edition — Acute appendicitis is the most common surgical emergency in children. Peak incidence 10-18 years. Pediatric Appendicitis Score (PAS): ≥8 suggests appendicitis. Imaging: Ultrasound first (avoids radiation), CT if equivocal. Treatment: Laparoscopic appendectomy. Non-operative management with antibiotics alone is increasingly used for uncomplicated appendicitis. Perforated appendicitis with abscess: percutaneous drainage + interval appendectomy.

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📋 30 Clinical Scenarios — Acute Appendicitis

📇 High‑Yield Review Cards (Acute Appendicitis)

🩺 Clinical Presentations: Acute Appendicitis

Select a presentation for diagnostic clues and management.

📋 Stepwise Evaluation & Management of Acute Appendicitis

🔑 Key Principles — Acute Appendicitis (Nelson Ch.391)
• Classic presentation: Periumbilical pain → migrates to RLQ, anorexia, nausea, vomiting, fever, RLQ tenderness.
• Pediatric Appendicitis Score (PAS): Fever, anorexia, nausea/vomiting, cough/percussion/hopping tenderness, RLQ tenderness, migration of pain, leukocytosis, PMN >75%. Score ≥8 → high risk.
• Imaging: Ultrasound first (non-visualized appendix + secondary signs). CT with IV contrast for equivocal cases.
• Treatment: Laparoscopic appendectomy + perioperative antibiotics. Non-operative management (antibiotics alone) for uncomplicated appendicitis (controversial).
• Perforated appendicitis/abscess: IV antibiotics + percutaneous drainage, interval appendectomy in 4-6 weeks.

    ⚡ Reflex Prompts — Appendicitis Clinical Decisions

    📖 Acute Appendicitis — Core Summary (Nelson Ch.391)