From the Guidelines
Appendicitis typically presents with pain that begins around the navel and then shifts to the lower right abdomen, becoming more intense over several hours, as reported in the most recent study by 1. This pain often worsens with movement, coughing, or deep breathing. Other common signs include:
- Loss of appetite
- Nausea
- Vomiting
- Low-grade fever (99-102°F)
- Constipation or diarrhea
- Abdominal bloating
- The inability to pass gas Many patients experience rebound tenderness, where pain intensifies when pressure on the abdomen is suddenly released. Some people may also notice a specific tenderness point (McBurney's point) located about two-thirds of the way between the navel and right hip bone. These symptoms occur because the appendix becomes inflamed and infected, often due to a blockage that allows bacteria to multiply, as explained in 1. The progression of symptoms typically happens quickly, within 24-48 hours. If you experience persistent abdominal pain, especially if it migrates to the lower right abdomen and is accompanied by fever, nausea, or vomiting, seek immediate medical attention as untreated appendicitis can lead to rupture, causing peritonitis, a serious infection that can be life-threatening, as highlighted in 1 and 1. It's essential to note that the presentation of appendicitis can vary, especially in elderly patients, where the typical triad of migrating right lower quadrant pain, fever, and leucocytosis is infrequently observed, as discussed in 1. In such cases, a high index of suspicion and the use of scoring systems, such as the Alvarado score, can aid in diagnosis, although with limited reliability in the elderly population, as reported in 1. Given the potential severity of appendicitis, it's crucial to prioritize prompt medical evaluation and treatment to minimize the risk of complications and improve outcomes, as emphasized in 1.
From the Research
Signs and Symptoms of Appendicitis
- The classic symptoms of appendicitis include:
- Vague periumbilical pain
- Anorexia/nausea/intermittent vomiting
- Migration of pain to the right lower quadrant
- Low-grade fever 2
- These symptoms are present in approximately 90% of patients diagnosed with acute appendicitis 2
Diagnosis and Treatment
- The diagnosis of acute appendicitis is based on history, physical examination, laboratory evaluation, and imaging 2
- Laparoscopic appendectomy is the most common treatment for acute appendicitis, but broad-spectrum antibiotics can successfully treat uncomplicated cases in approximately 70% of patients 2
- Specific imaging findings, such as appendiceal dilatation or presence of appendicoliths, can help identify patients who may not respond to antibiotic treatment 2
Imaging Findings and Treatment Approach
- CT findings of appendicolith, mass effect, and a dilated appendix greater than 13 mm are associated with a higher risk of treatment failure with an antibiotics-first approach 2
- Surgical management is recommended for patients with these high-risk CT findings who are fit for surgery 2
- For patients without high-risk CT findings, either appendectomy or antibiotics can be considered as first-line therapy 2