Appendicitis in Pregnancy - SNguyen

Appendicitis in Pregnancy - SNguyen - Appendicitis in...

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Unformatted text preview: Appendicitis in Pregnancy Scott Nguyen Elmhurst Hospital Center October 29, 2003 Epidemiology Same risk as general population 1/1500 1/2000 Pregnancies 30% 1 st Trimester 45% 2 nd Trimester 25% 3 rd Trimester Maternal Physiology Gravid uterus will compress IVC in supine position Decreases venous return, preload, CO up to 25% Pts should be placed in left lateral tilt position Hypervolemic state Pt w/ signs of hypovolemia (sepsis) significantly volume depleted (30-50% blood volume) Anemia Typical Hcts 30-35% (d/t increased intravascular volume in pregnancy) Hypercoagualable state Increase in coagulation factors, venous stasis of pregnancy -> 4- 6x risk of thromboembolic complications Uterus limits ability of omentum migration Decreased ability to wall off infection The Mortality of appendicitis complicating pregnancy is the mortality of delay- Babler, 1908 1908 study 24% maternal, 40% fetal mortality in pregnancy Increased complications of appendicitis in pregnancy d/t delay in diagnosis Presentation Appendix location cephalad 12 weeks -- McBurneys point 24 weeks Iliac crest 36 weeks RUQ quadrant Peritoneal signs often absent d/t lifting of abdominal wall by uterus Nausea, vomiting, anorexia nonspecific Fever in less than majority Elevated WBC normal in pregnancy 15K in 1 st 2 nd trimesters 20 30K at labor <10K more reassuring Position of Appendix Baer et al, 1932 Differential Diagnosis Nonobstetric...
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This note was uploaded on 12/21/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Appendicitis in Pregnancy - SNguyen - Appendicitis in...

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