What are the signs of acute appendicitis (inflammation of the appendix)?

From the Guidelines

The key signs of appendicitis include sudden onset of pain in the lower right abdomen, pain that worsens with movement or coughing, nausea and vomiting, loss of appetite, low-grade fever, abdominal bloating, constipation or diarrhea, and these symptoms require immediate medical attention. According to the most recent guidelines, the diagnosis of acute appendicitis is often challenging and involves a synthesis of clinical, laboratory, and radiological findings 1. The clinical presentation of appendicitis is often inconsistent, and atypical presentations may result in delay in treatment 1.

Some of the key signs and symptoms of appendicitis include:

• Sudden onset of pain in the lower right abdomen
• Pain that worsens with movement or coughing
• Nausea and vomiting
• Loss of appetite
• Low-grade fever (99-102°F)
• Abdominal bloating
• Constipation or diarrhea

If you experience these symptoms, especially severe abdominal pain that migrates to the lower right side, seek immediate medical attention, as appendicitis is a medical emergency that requires prompt treatment to prevent potentially life-threatening complications 1. A doctor will perform a physical exam and may order imaging tests like an ultrasound or CT scan to confirm the diagnosis. The use of clinical scoring systems, such as the Alvarado score, and laboratory tests, such as a complete blood count, can aid in the diagnosis of appendicitis 1.

Early diagnosis is crucial to prevent complications like appendix rupture, and emergency surgery (appendectomy) is usually necessary to remove the infected appendix 1. The treatment of acute appendicitis may involve antibiotic therapy, but appendectomy remains the treatment of choice, especially for complicated appendicitis 1. Laparoscopic appendectomy is a viable approach to surgical treatment, but open appendectomy may still be necessary in some cases, especially in areas with limited access to diagnostic and interventional radiology 1.

In patients with periappendiceal abscess, percutaneous image-guided drainage may be an effective treatment option, but surgery may be necessary if drainage is not available 1. The role of interval appendectomy in the management of appendicitis is still debated, but it may not be necessary following initial non-operative treatment of complicated appendicitis, unless the patient experiences recurrent symptoms 1.

Overall, the diagnosis and treatment of acute appendicitis require a comprehensive approach that takes into account the patient's clinical presentation, laboratory results, and imaging findings, and prompt treatment is essential to prevent potentially life-threatening complications 1.

From the Research

Signs and Symptoms of Acute Appendicitis

• Classic symptoms of appendicitis include:
  • Vague periumbilical pain 2, 3, 4
  • Anorexia, nausea, and intermittent vomiting 2, 3, 4
  • Migration of pain to the right lower quadrant 2, 3, 4
  • Low-grade fever 2
• Other signs and symptoms:
  • Abdominal rigidity 4
  • Periumbilical pain radiating to the right lower quadrant 4
  • Absent or decreased bowel sounds 4
  • Positive psoas sign, positive obturator sign, and positive Rovsing sign 4
• Atypical presentations:
  • Sub-hepatic, sub-serosal, and retroperitoneal location of the appendix can lead to delayed diagnosis and management due to its atypical presentation 5

Diagnostic Findings

• Laboratory tests:
  • Leukocytosis with a left shift 5
• Imaging modalities:
  • Ultrasound 4, 5
  • Computed tomography (CT) 2
  • Magnetic resonance imaging (MRI) 6
• Clinical scores:
  • Alvarado score, Pediatric Appendicitis Score, and Appendicitis Inflammatory Response score can help in making a timely diagnosis 4

Treatment and Management

• Surgical management:
  • Laparoscopic appendectomy is the standard treatment for acute appendicitis 2, 6, 4
  • Open appendectomy is an option in case of difficulty or resource limitation 5
• Nonoperative management:
  • Antibiotics can be considered as first-line therapy in selected patients with uncomplicated appendicitis 2, 6, 4
  • Percutaneous drainage and antibiotic management for patients with a large appendiceal abscess or phlegmon 6