Treating Acute Appendicitis

Four Important Takeaways

1

Begin at Bedside

After you after made the diagnosis treatment begins with resuscitation, IV antibiotics and a decision: "To the OR, to the Floor or to the ICU"

2

Nonoperative approach

In both adults and children a nonoperative approach is possible, you need to understand the risks, benefits, indications and contraindications.

3

Simple or Complicated

Everything gets easier if you get simple. Divide appendicitis into simple or complicated and this will help determine the need for ongoing antibiotics and anticipate hospital stay.

4

Clinical Prediction Rules

Interval appendectomy is indicated if there is an obstructive mass or fecalith and in those patients with an increased risk of malignancy, for example persons over the age of 45 with appendicitis. Timing? 12 weeks after diagnosis!

Notes from the Video

What You're Going to Learn from This Video on Treating Appendicitis

As a surgeon one of the most common operations I do every week is a laparoscopic appendectomy...removing a child's appendix.

But the treatment of appendicitis begins before you get to the operating room, it begins immediately after diagnosis.

Here are the things we're going to be confident about with today's video:

1. How do we begin treating acute appendicitis?

2. What are the indications and contraindications for nonoperative treatment of appendicitis?

3. When do we decide to operate for appendicitis?

4. What are our options when operating for appendicitis?

5. When do we decide to delay operation with an interval appendectomy?

1. How do we begin treating acute appendicitis?

Treating appendicitis begins at the bedside with resuscitation, antibiotics and a decision on disposition.

The patient will be made NPO (nil per os) in preparation for possible surgery and intravenous access obtained.

In children I will begin with a 20ml/kg bolus of normal saline and observe to see if the child needs another bolus by looking at heart rate and urine output and hydration level.

In adults 1000ml is a good initial volume unless the patient has comorbid heart failure, if that is the case then I will be more careful with the fluid resuscitation.

Simultaneously we want to begin intravenous antibiotics.

If suspecting simple appendicitis a second generation cephalosporin is a good choice, if complicated appendicitis is suspected or the patient has SIRS, sepsis or septic shock then piperacillin/tazobactam is a good choice.

Finally, a decision needs to be made. Are we going to the operating room, the floor or the ICU?

2. What are the indications and contraindications for nonoperative treatment of appendicitis?

Four Important Takeaways

1

Begin at Bedside

2

Nonoperative approach

3

Simple or Complicated

4

Clinical Prediction Rules

Notes from the Video

What You're Going to Learn from This Video on Treating Appendicitis

As a surgeon one of the most common operations I do every week is a laparoscopic appendectomy...removing a child's appendix.

But the treatment of appendicitis begins before you get to the operating room, it begins immediately after diagnosis.

Here are the things we're going to be confident about with today's video:

1. How do we begin treating acute appendicitis?

2. What are the indications and contraindications for nonoperative treatment of appendicitis?

3. When do we decide to operate for appendicitis?

4. What are our options when operating for appendicitis?

5. When do we decide to delay operation with an interval appendectomy?

1. How do we begin treating acute appendicitis?

Treating appendicitis begins at the bedside with resuscitation, antibiotics and a decision on disposition.

﻿

The patient will be made NPO (nil per os) in preparation for possible surgery and intravenous access obtained.

In children I will begin with a 20ml/kg bolus of normal saline and observe to see if the child needs another bolus by looking at heart rate and urine output and hydration level.

In adults 1000ml is a good initial volume unless the patient has comorbid heart failure, if that is the case then I will be more careful with the fluid resuscitation.

Simultaneously we want to begin intravenous antibiotics.

If suspecting simple appendicitis a second generation cephalosporin is a good choice, if complicated appendicitis is suspected or the patient has SIRS, sepsis or septic shock then piperacillin/tazobactam is a good choice.

Finally, a decision needs to be made. Are we going to the operating room, the floor or the ICU?

2. What are the indications and contraindications for nonoperative treatment of appendicitis?