NMS. Casos Clínicos

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Part II ♦ Specific Disorders

Q: How might the following situations change the presentation of appendicitis? Case Variation 8.14.13. Advanced age (75 years)

◆ ◆ Older patients do not typically present with the classical history of periumbilical pain migrating to RLQ pain. Usually, they present with vague abdominal complaints, sepsis, altered consciousness, or failure to thrive. Case Variation 8.14.14. Childhood (5 years) ◆ ◆ Children more often present with appendicitis in which the appendix has ruptured. Case Variation 8.14.15. High doses of corticosteroids ◆ ◆ Steroids can mask most or all signs and symptoms of any inflammatory process. In addi- tion, the body’s attempt to “wall off ” inflammation and abscesses is blunted with steroids. Therefore, in many cases, the warning signs are absent until perforation occurs and sepsis develops. Thus, a high index of suspicion is necessary. It is essential to be very cautious with patients who are taking steroids. Case Variation 8.14.16. Pregnancy ◆ ◆ Appendicitis can occur during pregnancy. As the uterus enlarges, it pushes the appen- dix cephalad and laterally. Thus, the pain is in the upper lateral abdomen (Fig. 8-15).

3 mo. 4 mo. 5 mo. 6 mo. 7 mo. 8 mo.

Umbilicus

McBurney 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 1999:1068.) pp, pre-pregnancy. SAMPLE PP Figure 8-15: Location of pain of appendicitis in pregnancy. (From Yamada T, Alpers DH, LaMe L, et al, eds. Textbook of Gastroenterology ,