7, 8 The signs and symptoms that best rule in acute appendicitis in adults are right lower quadrant pain (positive likelihood ratio = 7.3 to 8.5), abdominal rigidity (LR+ = 3.8), and radiation of periumbilical pain to the right lower quadrant (LR+ = 3.2). Table 1 presents likelihood ratios of various signs and symptoms in adults and children. The variable location of the appendix causes variations in the clinical presentation, making diagnosis challenging, especially in pregnant women. Individual signs and symptoms are more helpful at ruling in the diagnosis than they are at ruling it out when absent.
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6ĭiagnosing acute appendicitis accurately and efficiently can reduce morbidity and mortality from perforation and other complications. 2 – 5 Appendicitis is thought to be caused by luminal obstruction from various etiologies, leading to increased mucus production and bacterial overgrowth, resulting in wall tension and, eventually, necrosis and potential perforation. 2 More than 300,000 appendectomies are performed each year in the United States, and less than 10% result in the removal of a normal appendix. 1 It is the most common nonobstetric surgical emergency during pregnancy, with an incidence of 6.3 per 10,000 pregnancies during the antepartum period (compared with 9.6 per 10,000 in nonpregnant persons) and increasing to 9.9 per 10,000 postpartum. In moderate- to high-risk patients, surgical consultation should be accomplished quickly to reduce morbidity and mortality resulting from perforation.Īppendicitis is one of the most common causes of acute abdominal pain, with a lifetime risk of 8.6% in males and 6.7% in females. Prolonged duration of symptoms before surgical intervention raises the risk. Perforation can lead to sepsis and occurs in 17% to 32% of patients with acute appendicitis. Pain control with opioids, nonsteroidal anti-inflammatory drugs, and acetaminophen should be a priority and does not result in delayed or unnecessary intervention. However, intravenous antibiotics may be considered first-line therapy in selected patients. Appendectomy via open laparotomy or laparoscopy is the standard treatment for acute appendicitis. Recommended first-line imaging consists of point-of-care or formal ultrasonography. The Alvarado score, Pediatric Appendicitis Score, and Appendicitis Inflammatory Response score incorporate common clinical and laboratory findings to stratify patients as low, moderate, or high risk and can help in making a timely diagnosis. Absent or decreased bowel sounds, a positive psoas sign, a positive obturator sign, and a positive Rovsing sign are most reliable for ruling in acute appendicitis in children. Right lower quadrant pain, abdominal rigidity, and periumbilical pain radiating to the right lower quadrant are the best signs for ruling in acute appendicitis in adults. Findings from the history, physical examination, and laboratory studies aid in the diagnosis of acute appendicitis. It is the most common nonobstetric surgical emergency during pregnancy. Appendicitis is one of the most common causes of acute abdominal pain in adults and children, with a lifetime risk of 8.6% in males and 6.7% in females.