What are the signs of appendicitis?

From the Guidelines

Appendicitis is typically characterized by pain that begins around the navel and then shifts to the lower right abdomen, becoming more intense over several hours, and is often accompanied by nausea, vomiting, loss of appetite, and low-grade fever. The diagnosis of appendicitis can be challenging, especially in pediatric patients, as the classic presenting symptoms are not always elicited and are only moderately reproducible between clinicians 1. The most common signs of appendicitis include:

• Pain that begins around the navel and then shifts to the lower right abdomen
• Nausea and vomiting
• Loss of appetite
• Low-grade fever (99-102°F)
• Constipation or diarrhea
• Abdominal bloating
• Inability to pass gas
• Rebound tenderness, where pain increases when pressure on the abdomen is suddenly released
• Tenderness at the McBurney's point, located about two-thirds of the way from the navel to the right hip bone These symptoms occur because the appendix becomes inflamed and infected, often due to a blockage that allows bacteria to multiply 1. According to the most recent study, the use of imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can help diagnose appendicitis and other causes of right lower quadrant pain 1. It is essential to seek immediate medical attention if symptoms of appendicitis are experienced, as untreated appendicitis can lead to rupture, causing peritonitis, a serious infection that can be life-threatening 1. Do not take pain medications, laxatives, or use heating pads before evaluation, as these may mask symptoms or worsen the condition 1. The choice of imaging modality should be tailored for diagnosis of acute appendicitis in patients with a high degree of suspicion, and should also allow diagnosis of other causes of right lower quadrant pain to triage appropriate patient management 1.

From the Research

Signs of Appendicitis

The signs of appendicitis can vary, but common symptoms include:

• Abdominal pain, particularly in the right lower quadrant [(2,3)]
• Nausea and vomiting 3
• Fever 3
• Abdominal tenderness and guarding 4
• Rebound tenderness 3
• Psoas sign, obturator sign, and Rovsing sign may be positive in some cases 3

Atypical Presentations

In some cases, appendicitis can present with atypical symptoms, such as:

• Left lower quadrant pain 2
• Chronic right lower quadrant abdominal pain 5
• Absence of fever, peritoneal tenderness, and leukocytosis 5

Diagnostic Criteria

The diagnosis of appendicitis is often based on a combination of clinical criteria, including:

• History and physical examination [(3,4)]
• Laboratory studies, such as white blood cell count and urinalysis 4
• Imaging studies, such as ultrasound and computed tomography (CT) scans [(3,4,5)]
• Scoring systems, such as the Alvarado score and Pediatric Appendicitis Score 3