GENERAL SURGERY
GENERAL SURGERY
Embedded Files
APPENDICITIS
APPENDICITIS
ABOUT THIS SESSION
ABOUT THIS SESSION
This is a self-directed learning resource designed to be worked through in the clinical environment.
Learning objectives:
Learning objectives:
- Demonstrate a thorough and structured approach to taking a history for acute abdominal pain
- Suggest key differential diagnoses for acute abdominal pain
- Suggest relevant investigations to assess for appendicitis
- Recognise clinical features suggesting a need for antibiotics and when urgent operative intervention is required
- Appreciate practical aspects of fasting for scans and theatre (most relevant for final years preparing for clinical practice)
Total time:
60 minNumber of students:
1-5Grade of students:
3rd to 5th year medical studentsCreated by:
Dr Harriet MitchellUploaded:
19th September 2019Last updated:
19th September 2019Resources needed for this session:
Resources needed for this session:
Access to local microbiology guidelines, pen, paper
Resources linked to this session:
Resources linked to this session:
Activity 1: History Taking and Examination Skills
20 minActivity 1: History Taking and Examination Skills
Take a focused history from a patient with suspected appendicitis to include relevant past medical history, drug history, social history and family history. Following this, perform a focused abdominal examination.
Activity 2: Documentation Skills and Diagnostic Reasoning
10 minActivity 2: Documentation Skills and Diagnostic Reasoning
Using an acute surgical clerking proforma, document your clinical findings.
Suggest three differential diagnoses and give two features from the history/examination that support each one.
Consider:
- What are the key investigations needed to differentiate between the causes of this patient's symptoms?
- What might these investigations show which would suggest a diagnosis of appendicitis?
- What kind of imaging would be appropriate in this case?
Activity 3: Investigations
5 minActivity 3: Investigations
Review the patient's initial investigation results e.g. blood tests, imaging results. If none are available, use the examples below.
Consider:
- What are the key abnormalities found on these investigation results?
- How does this result alter your differential diagnosis?
- Consider when CT imaging might be indicated in cases of suspected appendicitis.
Urine dipstick
Leucocytes neg
Nitrites neg
Protein neg
Blood neg
Ketones ++
Glucose neg
Blood tests
Na 143
Potassium 3.9
Urea 7.0
Creat 67
CRP 36
WCC 13.1
Neuts 12.4
Hb 135
USS Abdo/Pelvis Report
Ovaries and uterus visualised were normal. No ovarian cysts visualised on this scan. Gallbladder thin walled, no gallstones seen. CBD 4mm. Pancreas obscured by bowel gas. Kidneys and bladder grossly normal. Trace of free fluid seen. Appendix not visualised.
Activity 4: Management
10 minActivity 4: Management
Consider the scenario that the patient you have seen needs to be kept nil-by-mouth for urgent surgery.
Find a fluid prescription chart and complete the following tasks:
- Prescribe suitable fluids for a 24 hour period. This should include appropriate resuscitation and maintenance fluid, including electrolyte replacement, where appropriate.
- Prescribe an appropriate antibiotic for the patient, using hospital or local guidelines where possible.
- Prescribe an appropriate antiemetic for the patient.
What other factors need to be considered for the patient you have seen if they were to undergo urgent surgery e.g. diabetes management, withholding medications/anticoagulants etc.
Summary and Feedback
Summary and Feedback
Highlight three key things you have learned today. Summarise them on a post-it note and keep it somewhere you will find in a week or two.
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References and Further Reading
References and Further Reading
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