Acute appendicitis is an acute inflammation of the vermiform appendix.
Typically presents as acute abdominal pain starting in the mid-abdomen and later localizing to the right lower quadrant.
Associated with fever, anorexia, nausea, vomiting, and elevation of the neutrophil count.
Diagnosis is usually made clinically. If investigation is required, computed tomography scan or ultrasonography may show dilatation of the appendix outer diameter to more than 6 mm.
Definitive treatment is surgical appendectomy. A nonoperative, antibiotic-only approach may be feasible in select patient populations.
History and exam
Key diagnostic factors
- abdominal pain
- right lower quadrant tenderness
Other diagnostic factors
- age of occurrence
- diminished bowel sounds
- Rovsing sign
- psoas sign
- obturator sign
- <6 months of breastfeeding
- low dietary fiber
- improved personal hygiene
1st investigations to order
- abdominal and pelvic CT scan
- urinary pregnancy test
Investigations to consider
- abdominal ultrasound
- abdominal and pelvic MRI in pregnancy
uncomplicated acute appendicitis
ill with perforation or abscess
Peter Szasz, MD, PhD, FRCSC
Department of Surgery
PS declares that he has no competing interests.
Dr Peter Szasz would like to gratefully acknowledge Professor Ali Tavakkoli, Professor Dileep N. Lobo and Dr Nasim Ahmed, previous contributors to this topic. 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.
John M. Davis, MD
Jersey Shore Medical Center
JMD declares that he has no competing interests.
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