hello I'm Tom Cook I'm an Emergency Physician in Columbia South Carolina today I'm going to demonstrate the technique for evaluating the appendix now I all know appendicitis is the most common surgical emergency and so you have a lot of opportunity to use ultrasound to see if you can make the diagnosis or rule out the disease the examination itself is notorious for being very very specific but not entirely sensitive so it's a nice examination to rule in the disease but many times you don't see the appendix and you can't rule out the disease and you'll go on to CT ideally your patients will be very very thin and that allows you to use a linear array transducer to do the evaluation because you're looking at something that is so very small that linear Ray and that high frequency will give you the resolution that you need to do the exam we're going to place a small amount of gel in the right lower quadrant I've set the preset on this examination to a linear Ray looking at small organs we'll start in the axial plane and the first thing you want to be able to recognize are the iliac vessels you can see the iliac artery is more superficial and the vein is deep to the artery and then once you find that down here you're basically going to start moving your transducer cephalad looking for the appendix and as you move up into the abdomen you're looking for what else a worm like or tube-like structure that is the appendix and right there you can see it it goes right over the iliac artery and you can see it's a multi-layered structure with aluminum you want to be able to compress that structure and see if there's any tenderness and you also want to see if by chance there's an appendicular in the appendix which would of course give you a shadow and be another indicator that you had a positive exam in this situation the appendix is normal there's no tenderness to compression and in this particular case we could say that this patient does not have an appendicitis I caution you again stress is very specific it's not entirely sensitive but in many patients particularly in children it's a great exam to have in your tool bag it'll expedite the patient's care and it'll also let you focus on other pathologies which might be causing the patient's pain foreign
