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: Appendicitis in children: often difficult
to diagnose
DEAR DR.PAUL: I was wondering, do children get appendicitis,
and if so, what are the signs of appendicitis in children?
PEDIATRICIAN DR.PAUL ANSWERS: The answer
to your first question is easy. Yes, children can suffer from
appendicitis. Your second question is a bit more complicated.
First, let me explain what appendicitis is. It is the inflammation
(usually infection) of the appendix, which is a small extension
or pouch of the large intestine. What is the role of the appendix?
It is believed, just like the tonsils, that the appendix may
be involved in the development of the immune system as a baby
develops in the uterus.
Now to your next question: The classic symptoms of appendicitis
in adults as acute (sudden onset) abdominal pain, typically,
starting around the belly button area and then moving down to
the right lower side of the abdomen. There can be nausea with
or without vomiting, and there may be a low-grade fever. There
are also some very specific findings that a doctor looks for
when examining a person with suspected appendicitis, including
very tender right lower abdomen, and pain in the same area with
movement of the body (jumping up and down or even walking).
There are really no specific tests to confirm the diagnosis.
A blood test and regular X -Ray of the abdomen may or met not
be helpful. More recently ultrasounds have been found helpful
in confirming appendicitis.
The diagnosis is made based on an evaluation by a surgeon. If
the surgeon strongly suspects appendicitis, then the treatment
is to operate and remove the inflamed appendix. This is the
only treatment of appendicitis, because if left untreated, the
appendix will become so inflamed and swollen, that it will rupture.
A ruptured appendix is quite serious and potentially life threatening;
the material normally in the appendix, full of bacteria, spreads
within the abdomen and can get into the blood. If this happens,
aside from surgery, antibiotics are needed after the operation
for a prolonged period to prevent spread of infection. Fortunately,
in most cases, the appendix is removed before it ruptures, usually
with a quick recovery and without the need for other treatments.
Before talking about the symptoms in kids, it is important to
understand that abdominal pain in childhood is quite common,
accounting for tens of thousands of doctor visits annually:
But only a very small percentage of children with abdominal
pain actually have appendicitis. However, when appendicitis
occurs in children, it can present as I have described above,
but can also reveal itself with very non-specific or non-typical
symptoms. Every one training in Pediatrics or Pediatric Surgery
can attest to the fact that at one time or another they have
been fooled; diagnosing something else, and indeed it ending
up being appendicitis. If the doctor or surgeon is not fully
convinced that this is appendicitis, there are several options,
depending on the individual situation: A physician may send
the child home advising the parents to bring the child right
back if the pain worsens or persists. Still in other cases,
the child might be admitted to hospital for observation.
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