Hi, this is Tom, and in this episode I'm going to be going through appendicitis in children.

And you can find notes at zero to finals.com and in the zero to finals pediatrics book.

And you can find flashcards and questions at members.0.0.0.com. And at the end of this episode,

we'll go through some questions so you can test yourself on what you just heard. So let's jump straight in.

Appendicitis is inflammation of the appendix. The peak incidence of appendicitis is in patients aged 10 to 20 years.

It can occur at any age, but is less common in young children and adults over the age of 50.

Let's talk about the basic pathophysiology.

The appendix is a small, thin tube that arises from the seacum.

It's located at the point where the three tiniacolae meet,

and these are the longitudinal muscles that run the length of the large intestine.

There is a single opening to the appendix that connects to the bowel, and at the end of the

appendix there's a dead end. Pathogens can get trapped due to obstruction at the point

where the appendix meets the bowel.

Trapping of pathogens leads to infection and inflammation.

The inflammation may proceed to gangrene and rupture.

When the appendix ruptures, fecal contents and infective material are released into the peritoneal cavity.

This leads to peritonitis, which is inflammation of the peritoneal lining.

Let's talk about the presentation.

The key presenting feature of appendicitis is abdominal pain.

This typically starts as central abdominal pain that moves down to the right iliac fossa within the first 24 hours, eventually becoming localized in the right iliac fossa.

On palpation of the abdomen, there is tenderness at McBurney's Point.

McBurney's Point refers to a specific area that is one-third of the distance from the anterior

...