Apendicitis aguda
Resumen
Definición
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].
Anamnesis y examen
Principales factores de diagnóstico
- dolor abdominal
- anorexia
- náuseas y vómitos
- sensibilidad a la palpación en el cuadrante inferior derecho
- Puntuación de riesgo "alta" o "intermedia"
- abdomen tenso y rígido
- hipotensión y taquicardia
- masa palpable
Otros factores de diagnóstico
- edad de presentación
- pirexia de bajo grado
- cara sonrojada y hedor
- reducción de los ruidos intestinales
- taquicardia
- deposición diarreica
- estreñimiento
- cadera derecha flexionada (signo del psoas)
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- hemograma completo (HC)
- proteína C-reactiva
- ultrasonido de abdomen
- TC abdominal con contraste
Pruebas diagnósticas que deben considerarse
- análisis de orina
- prueba de embarazo
- agrupe y guarde
- resonancia magnética (IRM) abdominal
Pruebas emergentes
- ratio de neutrófilos a linfocitos
- sodio sérico
- pentraxina-3
- amiloide A sérico
- índices plaquetarios
Algoritmo de tratamiento
Colaboradores
Consejeros especializados
John Abercrombie, FRCS
General and Colorectal Surgeon
Queen’s Medical Centre
Nottingham
UK
Biografía
JA is Clinical Lead for General Surgery, Getting It Right First Time.
Divulgaciones
JA is trustee and council member of the Royal College of Surgeons of England.
Agradecimientos
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work is retained in parts of the content:
Dileep N. Lobo, MS, DM, FRCS, FACS
Professor of Gastrointestinal Surgery
National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit
Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre
Nottingham
UK
DNL declares that he has no competing interests. DNL is an author of an article cited in the topic.
Peer reviewers
Sarah Richards
General Surgeon
Royal United Hospitals
Bath NHS Foundation Trust
UK
Biography
SR is a specialty advisor in emergency general surgery to the Royal College of Surgeons and an honorary senior clinical lecturer and examiner for the University of Bristol medical school.
Disclosures
SR declares that she has no competing interests.
Kokila Lakhoo, PhD, FRCS, FCS (Paediatrics) MRCPCH, MBCHB
Consultant Paediatric Surgeon
Children’s Hospital in Oxford and the University of Oxford
UK
Disclosures
KL 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
Gorter RR, Eker HH, Gorter-Stam MA, et al. Diagnosis and management of acute appendicitis: EAES consensus development conference 2015. Surg Endosc. 2016 Nov;30(11):4668-90.Full text Abstract
Association of Surgeons of Great Britain and Ireland; Royal College of Surgeons of England. Commissioning guide: emergency general surgery (acute abdominal pain). April 2014 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available here.
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