Summary
Definition
Acute appendicitis is an acute inflammation of the vermiform appendix, most likely due to obstruction of the lumen of the appendix (by fecalith, normal stool, infective agents, or lymphoid hyperplasia).[1][2][Figure caption and citation for the preceding image starts]: Acute appendicitis - intraoperative specimen.Nasim Ahmed, MBBS, FACS; used with permission [Citation ends].
History and exam
Key diagnostic factors
- abdominal pain
- anorexia
- nausea and vomiting
- right lower quadrant tenderness
- tense rigid abdomen
- hypotension and tachycardia
- palpable mass
Other diagnostic factors
- age of occurrence
- fever
- flushed face and a fetor
- diminished bowel sounds
- tachycardia
- loose stool
- constipation
- Rovsing sign
- psoas sign
- obturator sign
Risk factors
- improved personal hygiene
- smoking
Diagnostic tests
1st tests to order
- CBC
- CRP
- abdominal and pelvic CT scan
Tests to consider
- abdominal ultrasound
- urinalysis
- urinary pregnancy test
- abdominal and pelvic MRI in pregnancy
Emerging tests
- Neutrophil-to-lymphocyte ratio
- serum sodium
- pentraxin-3
- serum amyloid A
- platelet indices
Treatment algorithm
uncomplicated acute appendicitis
ill with perforation or abscess
Contributors
Authors
Peter Szasz, MD, PhD, FRCSC
Assistant Professor
Department of Surgery
Queen's University
Kingston
Ontario
Canada
Disclosures
PS declares that he has no competing interests.
Acknowledgements
Dr Peter Szasz would like to gratefully acknowledge Professor Ali Tavakkoli, Professor Dileep N. Lobo and Dr Nasim Ahmed, previous contributors to this topic.
Disclosures
AT is a consultant for Medtronic. DNL is the author of an article cited in the topic. NA declares that he has no competing interests.
Peer reviewers
John M. Davis, MD
General Surgery
Jersey Shore Medical Center
Neptune
NJ
Disclosures
JMD declares that he has no competing interests.
Elisabeth Adderson, MD
Associate Member
St. Jude Children's Research Hospital
Associate Professor of Pediatrics
University of Tennessee Health Sciences Center
Memphis
TN
Disclosures
EA declares that she has no competing interests.
Differentials
- Acute mesenteric adenitis
- Viral gastroenteritis
- Meckel diverticulitis
More DifferentialsGuidelines
- Critical issues in the evaluation and management of emergency department patients with suspected appendicitis
- Acute abdominal pain
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