Acute appendicitis
Summary
定义
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].
病史和体格检查
关键诊断因素
- abdominal pain
- anorexia
- nausea and vomiting
- right lower quadrant tenderness
- tense rigid abdomen
- hypotension and tachycardia
- palpable mass
其他诊断因素
- age of occurrence
- fever
- flushed face and a fetor
- diminished bowel sounds
- tachycardia
- loose stool
- constipation
- Rovsing sign
- psoas sign
- obturator sign
危险因素
- differences in the appendiceal microbiome
- smoking
诊断性检查
首要检查
- CBC
- CRP
- abdominal and pelvic CT scan
需考虑的检查
- abdominal ultrasound
- urinalysis
- urinary pregnancy test
- abdominal and pelvic MRI in pregnancy
新兴检查
- Neutrophil-to-lymphocyte ratio
- serum sodium
- pentraxin-3
- serum amyloid A
- platelet indices
治疗流程
uncomplicated acute appendicitis
ill with perforation or abscess
撰稿人
专家顾问
Peter Szasz, MD, PhD, FRCSC
Assistant Professor
Department of Surgery
Queen's University
Kingston
Ontario
Canada
利益声明
PS 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
利益声明
EA declares that she has no competing interests.
同行评议者
John M. Davis, MD
General Surgery
Jersey Shore Medical Center
Neptune
NJ
利益声明
JMD declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Di Saverio S, Podda M, De Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.全文 摘要
American College of Radiology. ACR appropriateness criteria: right lower quadrant pain - suspected appendicitis. 2022 [internet publication].全文
Sartelli M, Chichom-Mefire A, Labricciosa FM, et al. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2017 Jul 10;12:29.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Acute mesenteric adenitis
- Viral gastroenteritis
- Meckel diverticulitis
更多 鉴别诊断指南
- SAGES guideline for the diagnosis and treatment of appendicitis
- Acute abdominal pain
更多 指南医学计算器
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