Summary
Definition
La apendicitis aguda es una inflamación aguda del apéndice vermiforme, muy probablemente debida a la obstrucción del lumen del apéndice (mediante fecalito, heces normales, agentes infecciosos o hiperplasia linfoide).[1][2][Figure caption and citation for the preceding image starts]: Apendicitis aguda: muestra intraoperatoriaNasim Ahmed, MBBS, FACS; usado con autorización [Citation ends].
History and exam
Key diagnostic factors
- dolor abdominal
- anorexia
- náuseas y vómitos
- sensibilidad a la palpación en el cuadrante inferior derecho
- abdomen rígido y tenso
- hipotensión y taquicardia
- masa palpable
Other diagnostic factors
- edad de presentación
- fiebre
- cara sonrojada y hedor
- disminución de borborigmos
- taquicardia
- deposición diarreica
- estreñimiento
- signo de Rovsing
- signo del psoas
- signo del obturador
Risk factors
- diferencias en el microbioma apendicular
- tabaquismo
Diagnostic investigations
1st investigations to order
- hemograma completo (HC)
- proteína C-reactiva
- exploración por tomografía computarizada (TC) abdominal y pélvica
Investigations to consider
- ultrasonido de abdomen
- análisis de orina
- prueba de embarazo en orina
- imagen de resonancia magnética (IRM) abdominal y pélvica en el embarazo
Emerging tests
- ratio de neutrófilos a linfocitos
- sodio sérico
- pentraxina-3
- amiloide A sérico
- índices plaquetarios
Treatment algorithm
apendicitis aguda sin complicaciones
malestar con perforación o absceso
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 Paediatrics
University of Tennessee Health Sciences Center
Memphis
TN
Disclosures
EA declares that she 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.
References
Key articles
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.Full text Abstract
American College of Radiology. ACR appropriateness criteria: right lower quadrant pain - suspected appendicitis. 2022 [internet publication].Full text
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Diagnósticos diferenciais
- Adenitis mesentérica aguda
- Gastroenteritis viral
- Diverticulitis de Meckel
Mais Diagnósticos diferenciaisDiretrizes
- IDSA 2024 guideline update on the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intra-abdominal infections in adults, children, and pregnant people
- Acute abdominal pain
Mais DiretrizesFolhetos informativos para os pacientes
Apendicitis
Mais Folhetos informativos para os pacientesCalculadoras
Sistema de puntuación APACHE II
Mais CalculadorasVideos
Demostración animada de venopunción y flebotomía
Demostraciones animadas de técnicas de sutura prácticas
Mais vídeos
Conectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal