For Patients & General Readers
Acute appendicitis is a sudden inflammation of the appendix, a small pouch attached to the large intestine. It most commonly affects people between the ages of 10 and 30 and can cause severe abdominal pain that requires prompt medical attention to prevent serious complications.
Clinical Overview
Acute appendicitis is a common surgical emergency characterized by inflammation of the vermiform appendix, typically due to luminal obstruction. It presents with a constellation of symptoms and signs that necessitate urgent diagnostic evaluation and surgical intervention to prevent perforation and its sequelae.
Clinical Presentation
- Periumbilical pain migrating to the right lower quadrant (RLQ) is classic.
- Anorexia, nausea, and vomiting are frequently associated.
- Low-grade fever is common, but high fever may indicate complication.
- Tenderness on palpation of the RLQ is a hallmark sign.
- Changes in bowel habits, such as constipation or diarrhea, can occur.
Signs & Symptoms
Symptoms (Patient-Reported)
- Abdominal pain, often starting around the belly button and moving to the lower right side.
- Loss of appetite.
- Nausea.
- Vomiting.
- Fever.
- Feeling generally unwell.
Signs (Clinician-Observed)
- Tenderness at McBurney's point (one-third the distance from the anterior superior iliac spine to the umbilicus).
- Rebound tenderness (pain that worsens when pressure is released).
- Guarding (involuntary tensing of abdominal muscles).
- Rovsing's sign (pain in the RLQ when the LLQ is palpated).
Differential Diagnoses
| Condition | Distinguishing Feature |
|---|
| Ectopic Pregnancy | Occurs in women of childbearing age, often associated with vaginal bleeding and a positive pregnancy test. |
| Ovarian Torsion | Sudden onset of severe unilateral pelvic pain, often with nausea and vomiting, typically in young women. |
| Mesenteric Adenitis | Inflammation of lymph nodes in the abdomen, often follows a viral illness and is more common in children. |
| Kidney Stones (Ureterolithiasis) | Colicky flank pain radiating to the groin, often with hematuria. |
| Inflammatory Bowel Disease (e.g., Crohn's Disease) | Chronic, relapsing abdominal pain, diarrhea, weight loss, and often a history of gastrointestinal symptoms. |
| Diverticulitis | More common in older adults, typically left lower quadrant pain, fever, and changes in bowel habits. |
Red Flags — Seek Immediate Care
- Peritoneal signs (rigidity, diffuse tenderness, absent bowel sounds) suggesting perforation.
- High fever (>38.5°C) or hypothermia.
- Severe, unrelenting abdominal pain.
- Signs of sepsis (tachycardia, hypotension, altered mental status).
Key Investigations
- Complete blood count (CBC) with differential, often showing leukocytosis with a left shift.
- Urinalysis to rule out urinary tract infection or kidney stones.
- Abdominal ultrasound, particularly useful in children and pregnant women, to visualize the appendix.
- Computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast, highly sensitive and specific for appendicitis.
- Pregnancy test in women of childbearing age.
Management Overview
Management of acute appendicitis is primarily surgical, involving appendectomy. Antibiotics are typically administered pre-operatively and continued post-operatively, especially in cases of perforation. Conservative management with antibiotics alone is reserved for select, uncomplicated cases or in patients unfit for surgery.
Disclaimer: This article is for educational purposes only and does not constitute medical advice.
Always consult a qualified healthcare professional for diagnosis and treatment.
TruelyserMD does not replace clinical judgement.