Acute appendicitis

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Last reviewed: 13 Oct 2024
Last updated: 04 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • abdominal pain
  • anorexia
  • nausea and vomiting
  • right lower quadrant tenderness
  • tense rigid abdomen
  • hypotension and tachycardia
  • palpable mass
Full details

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
Full details

Risk factors

  • improved personal hygiene
  • smoking
Full details

Diagnostic tests

1st tests to order

  • CBC
  • CRP
  • abdominal and pelvic CT scan
Full details

Tests to consider

  • abdominal ultrasound
  • urinalysis
  • urinary pregnancy test
  • abdominal and pelvic MRI in pregnancy
Full details

Emerging tests

  • Neutrophil-to-lymphocyte ratio
  • serum sodium
  • pentraxin-3
  • serum amyloid A
  • platelet indices
Full details

Treatment algorithm

ACUTE

uncomplicated acute appendicitis

ill with perforation or abscess

Contributors

Expert advisers

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.

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.

Peer reviewers

John M. Davis, MD

General Surgery

Jersey Shore Medical Center

Neptune

NJ

Disclosures

JMD declares that he has no competing interests.

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