SURGERY ORAL EXAM APPENDICITIS
QUESTIONS AND ANSWERS
Young woman with RLQ pain.
Physical Exam? - Answer-*ASK FOR VITALS*
Full physical exam focusing on:
Abdominal exam: palpate RLQ last, feel for guarding and rigidity, percussion, rebound
tenderness, signs of peritonitis
-Dunphy's sign: coughing causes pain
-Rovsing's sign: pain in RLQ when palpating LLQ
-Obturator sign: pain on internal rotation of hip
-Psoas sign: pain on extension of right hip
Rectal exam: anterior tenderness during exam
Pelvic exam: cervical motion tenderness
Young woman with RLQ pain.
Labs? - Answer-*Pregnancy test*
CBC, CMP, U/A
Young woman with RLQ pain.
Imaging? - Answer-Ultrasound: non compressible appendix
CT abdomen/pelvis po/IV contrast: fat stranding, wall thickening (>7mm), target sign
Abdominal X-ray may show fecolith or sentinel loops
Young woman with RLQ pain.
Treatment? - Answer-Laparoscopic appendectomy, possible open
Pre-op antibiotics and IVF
When doing lap apply, if the appendix looks fine, what do you do? - Answer-Take it out,
look around the rest of the abdomen for cause of the symptoms. Meckle's, Chron's
lymphadenopathy, pelvic abscess, ovarian torsion (drain this- don't ask for OB consult)
When doing lap appy, if you find Chron's and there is gross infection at the base of the
appendix, what do you do? - Answer-Leave it in!
What are some post op complications? - Answer-Abscess, perforation, wound infection.
Look for post op fever, chills, and increased WBC
What do you do if patient has a post op abscess or leak? - Answer-Abscess- IR
drainage
Leak- surgical repair
What are the layers of the abdominal wall? - Answer-1. Skin
2. Subcutaneous fat
QUESTIONS AND ANSWERS
Young woman with RLQ pain.
Physical Exam? - Answer-*ASK FOR VITALS*
Full physical exam focusing on:
Abdominal exam: palpate RLQ last, feel for guarding and rigidity, percussion, rebound
tenderness, signs of peritonitis
-Dunphy's sign: coughing causes pain
-Rovsing's sign: pain in RLQ when palpating LLQ
-Obturator sign: pain on internal rotation of hip
-Psoas sign: pain on extension of right hip
Rectal exam: anterior tenderness during exam
Pelvic exam: cervical motion tenderness
Young woman with RLQ pain.
Labs? - Answer-*Pregnancy test*
CBC, CMP, U/A
Young woman with RLQ pain.
Imaging? - Answer-Ultrasound: non compressible appendix
CT abdomen/pelvis po/IV contrast: fat stranding, wall thickening (>7mm), target sign
Abdominal X-ray may show fecolith or sentinel loops
Young woman with RLQ pain.
Treatment? - Answer-Laparoscopic appendectomy, possible open
Pre-op antibiotics and IVF
When doing lap apply, if the appendix looks fine, what do you do? - Answer-Take it out,
look around the rest of the abdomen for cause of the symptoms. Meckle's, Chron's
lymphadenopathy, pelvic abscess, ovarian torsion (drain this- don't ask for OB consult)
When doing lap appy, if you find Chron's and there is gross infection at the base of the
appendix, what do you do? - Answer-Leave it in!
What are some post op complications? - Answer-Abscess, perforation, wound infection.
Look for post op fever, chills, and increased WBC
What do you do if patient has a post op abscess or leak? - Answer-Abscess- IR
drainage
Leak- surgical repair
What are the layers of the abdominal wall? - Answer-1. Skin
2. Subcutaneous fat
