History and exam

Key diagnostic factors

Constant mid-abdominal pain which later (1 to 12 hours) shifts to right lower quadrant. Usually worse on movement and coughing.

An important symptom almost always associated with acute appendicitis.[31] Without anorexia the diagnosis of acute appendicitis is in question.

A classic sign is right lower quadrant abdominal tenderness (McBurney sign). There may be localized rebound tenderness, especially if the appendix is anterior. Compressing the left lower quadrant may also elicit pain in the right lower quadrant (Rovsing sign). Pain may also be elicited with the patient lying on their left side and slowly extending the right thigh to cause a stretch in the iliopsoas muscle (psoas sign) or by internal rotation of the flexed right thigh (obturator sign).

Other diagnostic factors

May occur at any age but is most commonly seen in early teens to late 40s.

Nausea and vomiting are present in 75% of patients.[31]

Low-grade, usually 1.8°F (1°C) increase in body temperature.

Bowel sounds may be reduced, particularly on the right side compared with the left.

Tachycardia may be present, particularly in patients with perforation.[36]

Nausea and vomiting are present in 75% of patients.[31]

Pressing the left side of the abdominal cavity elicits pain in right lower quadrant.

Extending the right thigh on left lateral position elicits pain in right lower quadrant.

Pain is elicited in the right lower quadrant of abdomen by internal rotation of the flexed right thigh.

Risk factors

Affects immunologic responses to certain microbial organisms. Children who received <6 months of breastfeeding had a higher incidence of acute appendicitis compared with those who received >6 months of breastfeeding.[15][16]

Known to cause constipation. Children with appendectomies have low fiber in their diet compared with controls.[6][17] However, this theory is controversial.[18]

A higher incidence of acute appendicitis in Western society may be related to the living conditions and improved personal hygiene.[19]

A balance of gastrointestinal microbial flora is important for prevention of infection, for digestion, and providing important nutrients.[20] Frequent use of antibiotics and improved hygienic conditions lead to decreased exposure and/or imbalance of gastrointestinal microbial flora that may eventually lead to a modified response to viral infection and thereby trigger appendicitis.[21]

Children exposed to passive smoking have significantly increased incidence of acute appendicitis.[22] There is also an increased incidence of acute appendicitis in adult patients who smoke compared with adults who never smoked.[22][23]

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