Appendicitis/en - Revision history

FuzzyBot: Updating to match new version of source page

2026-01-15T15:32:53Z

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	{{AdultPage\|appendicitis (peds)}}		{{AdultPage\|appendicitis (peds)}}

	==Background==		==Background==

	[[File:Appendix locations.png\|thumb\|Drawing of colon with variability of appendix locations as seen from anterior view.]]		[[File:Appendix locations.png\|thumb\|Drawing of colon with variability of appendix locations as seen from anterior view.]]
	*Acute inflammation of the vermiform appendix		*Acute inflammation of the vermiform appendix
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	*Most commonly caused by luminal obstruction by a fecalith		*Most commonly caused by luminal obstruction by a fecalith
	*There are no historical or physical exam findings that can definitively rule out appendicitis		*There are no historical or physical exam findings that can definitively rule out appendicitis



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	[[File:McBurney's point.jpg\|thumb\|Location of McBurney's point (1), located two thirds the distance from the umbilicus (2) to the right anterior superior iliac spine (3).]]		[[File:McBurney's point.jpg\|thumb\|Location of McBurney's point (1), located two thirds the distance from the umbilicus (2) to the right anterior superior iliac spine (3).]]



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	**Retrocecal appendix can cause [[Special:MyLanguage/flank pain\|flank]] or [[Special:MyLanguage/pelvic pain\|pelvic pain]]		**Retrocecal appendix can cause [[Special:MyLanguage/flank pain\|flank]] or [[Special:MyLanguage/pelvic pain\|pelvic pain]]
	**Gravid uterus sometimes displaces appendix superiorly → [[Special:MyLanguage/RUQ pain\|RUQ pain]]		**Gravid uterus sometimes displaces appendix superiorly → [[Special:MyLanguage/RUQ pain\|RUQ pain]]



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	**Rebound		**Rebound
	**Rigidity		**Rigidity



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	\| 1.12		\| 1.12
	\|}		\|}



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	{{Abd DDX RLQ}}		{{Abd DDX RLQ}}



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	[[File:X-ray showing fecalith which has caused appendicitis.jpg\|thumb\|Fecalith (arrow) and stranding in the setting of acute appendicitis.]]		[[File:X-ray showing fecalith which has caused appendicitis.jpg\|thumb\|Fecalith (arrow) and stranding in the setting of acute appendicitis.]]
	[[File:CAT scan demonstrating acute appendicitis.jpg\|thumb\|Dialated appendix and stranding in the setting of acute appendicitis.]]		[[File:CAT scan demonstrating acute appendicitis.jpg\|thumb\|Dialated appendix and stranding in the setting of acute appendicitis.]]



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	{{Alvarado scoring system}}		{{Alvarado scoring system}}



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	*Consider CRP		*Consider CRP
	**Normal CRP AND WBC makes appendicitis unlikely		**Normal CRP AND WBC makes appendicitis unlikely



Line 176:		Line 187:
	**MRI		**MRI
	***When unable to identify appendix in children or pregnant women		***When unable to identify appendix in children or pregnant women



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	#[[Special:MyLanguage/Fluid resuscitation\|Fluid resuscitation]]		#[[Special:MyLanguage/Fluid resuscitation\|Fluid resuscitation]]
	#[[Special:MyLanguage/Analgesia\|Analgesia]]/[[Special:MyLanguage/antiemetics\|antiemetics]]		#[[Special:MyLanguage/Analgesia\|Analgesia]]/[[Special:MyLanguage/antiemetics\|antiemetics]]



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	{{Appendicitis Antibiotics}}		{{Appendicitis Antibiotics}}



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	**Patients who present <72 hours after the onset of symptoms usually undergo immediate appendectomy		**Patients who present <72 hours after the onset of symptoms usually undergo immediate appendectomy
	**Patients who present >72hrs and have perforated appendix may be treated initially with antibiotics, intravenous fluids, and bowel rest		**Patients who present >72hrs and have perforated appendix may be treated initially with antibiotics, intravenous fluids, and bowel rest



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	*Admission		*Admission



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	*Either a simple wound infection or an intraabdominal abscess		*Either a simple wound infection or an intraabdominal abscess
	**Typically in patients with perforated appendicitis		**Typically in patients with perforated appendicitis



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	*Treatment similar to that of primary appendicitis and likely requires surgical revision of the appendiceal stump or removal of retained tissue		*Treatment similar to that of primary appendicitis and likely requires surgical revision of the appendiceal stump or removal of retained tissue
	*Delay in diagnosis and treatment can result in perforation and sepsis		*Delay in diagnosis and treatment can result in perforation and sepsis



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	*[[Special:MyLanguage/Appendicitis (Peds)\|Appendicitis (Peds)]]		*[[Special:MyLanguage/Appendicitis (Peds)\|Appendicitis (Peds)]]



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	*[https://www.acep.org/patient-care/clinical-policies/appendicitis/ ACEP Clinical Policy Statement]		*[https://www.acep.org/patient-care/clinical-policies/appendicitis/ ACEP Clinical Policy Statement]
	*[http://www.emdocs.net/appendicitis-why-do-we-miss-it-and-how-do-we-improve/ emDocs - Appendicitis: Why Do We Miss It, and How Do We Improve?]		*[http://www.emdocs.net/appendicitis-why-do-we-miss-it-and-how-do-we-improve/ emDocs - Appendicitis: Why Do We Miss It, and How Do We Improve?]

FuzzyBot: Updating to match new version of source page

2026-01-15T13:44:36Z

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← Older revision		Revision as of 13:44, 15 January 2026
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	<languages/>		<languages/>

	{{~~Adult top}} [[Special:MyLanguage/appendicitis (peds)~~\|appendicitis (peds)]]		{{AdultPage\|appendicitis (peds)}}



	==Background==		==Background==

	[[File:Appendix locations.png\|thumb\|Drawing of colon with variability of appendix locations as seen from anterior view.]]		[[File:Appendix locations.png\|thumb\|Drawing of colon with variability of appendix locations as seen from anterior view.]]
	*Acute inflammation of the vermiform appendix		*Acute inflammation of the vermiform appendix
Line 14:		Line 10:
	*Most commonly caused by luminal obstruction by a fecalith		*Most commonly caused by luminal obstruction by a fecalith
	*There are no historical or physical exam findings that can definitively rule out appendicitis		*There are no historical or physical exam findings that can definitively rule out appendicitis



Line 20:		Line 17:

	[[File:McBurney's point.jpg\|thumb\|Location of McBurney's point (1), located two thirds the distance from the umbilicus (2) to the right anterior superior iliac spine (3).]]		[[File:McBurney's point.jpg\|thumb\|Location of McBurney's point (1), located two thirds the distance from the umbilicus (2) to the right anterior superior iliac spine (3).]]



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	**Retrocecal appendix can cause [[Special:MyLanguage/flank pain\|flank]] or [[Special:MyLanguage/pelvic pain\|pelvic pain]]		**Retrocecal appendix can cause [[Special:MyLanguage/flank pain\|flank]] or [[Special:MyLanguage/pelvic pain\|pelvic pain]]
	**Gravid uterus sometimes displaces appendix superiorly → [[Special:MyLanguage/RUQ pain\|RUQ pain]]		**Gravid uterus sometimes displaces appendix superiorly → [[Special:MyLanguage/RUQ pain\|RUQ pain]]



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	**Rebound		**Rebound
	**Rigidity		**Rigidity



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	\| 1.12		\| 1.12
	\|}		\|}



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	{{Abd DDX RLQ}}		{{Abd DDX RLQ}}



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	[[File:X-ray showing fecalith which has caused appendicitis.jpg\|thumb\|Fecalith (arrow) and stranding in the setting of acute appendicitis.]]		[[File:X-ray showing fecalith which has caused appendicitis.jpg\|thumb\|Fecalith (arrow) and stranding in the setting of acute appendicitis.]]
	[[File:CAT scan demonstrating acute appendicitis.jpg\|thumb\|Dialated appendix and stranding in the setting of acute appendicitis.]]		[[File:CAT scan demonstrating acute appendicitis.jpg\|thumb\|Dialated appendix and stranding in the setting of acute appendicitis.]]



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	{{Alvarado scoring system}}		{{Alvarado scoring system}}



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	*Consider CRP		*Consider CRP
	**Normal CRP AND WBC makes appendicitis unlikely		**Normal CRP AND WBC makes appendicitis unlikely



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	**MRI		**MRI
	***When unable to identify appendix in children or pregnant women		***When unable to identify appendix in children or pregnant women



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	#[[Special:MyLanguage/Fluid resuscitation\|Fluid resuscitation]]		#[[Special:MyLanguage/Fluid resuscitation\|Fluid resuscitation]]
	#[[Special:MyLanguage/Analgesia\|Analgesia]]/[[Special:MyLanguage/antiemetics\|antiemetics]]		#[[Special:MyLanguage/Analgesia\|Analgesia]]/[[Special:MyLanguage/antiemetics\|antiemetics]]



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	{{Appendicitis Antibiotics}}		{{Appendicitis Antibiotics}}



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	**Patients who present <72 hours after the onset of symptoms usually undergo immediate appendectomy		**Patients who present <72 hours after the onset of symptoms usually undergo immediate appendectomy
	**Patients who present >72hrs and have perforated appendix may be treated initially with antibiotics, intravenous fluids, and bowel rest		**Patients who present >72hrs and have perforated appendix may be treated initially with antibiotics, intravenous fluids, and bowel rest



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	*Admission		*Admission



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	*Either a simple wound infection or an intraabdominal abscess		*Either a simple wound infection or an intraabdominal abscess
	**Typically in patients with perforated appendicitis		**Typically in patients with perforated appendicitis



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	*Treatment similar to that of primary appendicitis and likely requires surgical revision of the appendiceal stump or removal of retained tissue		*Treatment similar to that of primary appendicitis and likely requires surgical revision of the appendiceal stump or removal of retained tissue
	*Delay in diagnosis and treatment can result in perforation and sepsis		*Delay in diagnosis and treatment can result in perforation and sepsis



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	*[[Special:MyLanguage/Appendicitis (Peds)\|Appendicitis (Peds)]]		*[[Special:MyLanguage/Appendicitis (Peds)\|Appendicitis (Peds)]]



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	*[https://www.acep.org/patient-care/clinical-policies/appendicitis/ ACEP Clinical Policy Statement]		*[https://www.acep.org/patient-care/clinical-policies/appendicitis/ ACEP Clinical Policy Statement]
	*[http://www.emdocs.net/appendicitis-why-do-we-miss-it-and-how-do-we-improve/ emDocs - Appendicitis: Why Do We Miss It, and How Do We Improve?]		*[http://www.emdocs.net/appendicitis-why-do-we-miss-it-and-how-do-we-improve/ emDocs - Appendicitis: Why Do We Miss It, and How Do We Improve?]

FuzzyBot: Updating to match new version of source page

2026-01-15T01:18:35Z

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← Older revision		Revision as of 01:18, 15 January 2026
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	<languages/>		<languages/>

	{{Adult top}}		{{Adult top}} [[Special:MyLanguage/appendicitis (peds)\|appendicitis (peds)]]
	[[Special:MyLanguage/appendicitis (peds)\|appendicitis (peds)]]


	==Background==		==Background==
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	*Most commonly caused by luminal obstruction by a fecalith		*Most commonly caused by luminal obstruction by a fecalith
	*There are no historical or physical exam findings that can definitively rule out appendicitis		*There are no historical or physical exam findings that can definitively rule out appendicitis



Line 18:		Line 20:

	[[File:McBurney's point.jpg\|thumb\|Location of McBurney's point (1), located two thirds the distance from the umbilicus (2) to the right anterior superior iliac spine (3).]]		[[File:McBurney's point.jpg\|thumb\|Location of McBurney's point (1), located two thirds the distance from the umbilicus (2) to the right anterior superior iliac spine (3).]]


	===History===		===History===
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	**Retrocecal appendix can cause [[Special:MyLanguage/flank pain\|flank]] or [[Special:MyLanguage/pelvic pain\|pelvic pain]]		**Retrocecal appendix can cause [[Special:MyLanguage/flank pain\|flank]] or [[Special:MyLanguage/pelvic pain\|pelvic pain]]
	**Gravid uterus sometimes displaces appendix superiorly → [[Special:MyLanguage/RUQ pain\|RUQ pain]]		**Gravid uterus sometimes displaces appendix superiorly → [[Special:MyLanguage/RUQ pain\|RUQ pain]]



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	**Rebound		**Rebound
	**Rigidity		**Rigidity



Line 104:		Line 109:
	\| 1.12		\| 1.12
	\|}		\|}



Line 109:		Line 115:

	{{Abd DDX RLQ}}		{{Abd DDX RLQ}}



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	[[File:X-ray showing fecalith which has caused appendicitis.jpg\|thumb\|Fecalith (arrow) and stranding in the setting of acute appendicitis.]]		[[File:X-ray showing fecalith which has caused appendicitis.jpg\|thumb\|Fecalith (arrow) and stranding in the setting of acute appendicitis.]]
	[[File:CAT scan demonstrating acute appendicitis.jpg\|thumb\|Dialated appendix and stranding in the setting of acute appendicitis.]]		[[File:CAT scan demonstrating acute appendicitis.jpg\|thumb\|Dialated appendix and stranding in the setting of acute appendicitis.]]


	===Appendicitis Risk Scores===		===Appendicitis Risk Scores===

	{{Alvarado scoring system}}		{{Alvarado scoring system}}



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	*Consider CRP		*Consider CRP
	**Normal CRP AND WBC makes appendicitis unlikely		**Normal CRP AND WBC makes appendicitis unlikely



Line 161:		Line 171:
	**MRI		**MRI
	***When unable to identify appendix in children or pregnant women		***When unable to identify appendix in children or pregnant women



Line 171:		Line 182:
	#[[Special:MyLanguage/Fluid resuscitation\|Fluid resuscitation]]		#[[Special:MyLanguage/Fluid resuscitation\|Fluid resuscitation]]
	#[[Special:MyLanguage/Analgesia\|Analgesia]]/[[Special:MyLanguage/antiemetics\|antiemetics]]		#[[Special:MyLanguage/Analgesia\|Analgesia]]/[[Special:MyLanguage/antiemetics\|antiemetics]]



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	{{Appendicitis Antibiotics}}		{{Appendicitis Antibiotics}}



Line 183:		Line 196:
	**Patients who present <72 hours after the onset of symptoms usually undergo immediate appendectomy		**Patients who present <72 hours after the onset of symptoms usually undergo immediate appendectomy
	**Patients who present >72hrs and have perforated appendix may be treated initially with antibiotics, intravenous fluids, and bowel rest		**Patients who present >72hrs and have perforated appendix may be treated initially with antibiotics, intravenous fluids, and bowel rest



Line 188:		Line 202:

	*Admission		*Admission



Line 197:		Line 212:
	*Either a simple wound infection or an intraabdominal abscess		*Either a simple wound infection or an intraabdominal abscess
	**Typically in patients with perforated appendicitis		**Typically in patients with perforated appendicitis



Line 207:		Line 223:
	*Treatment similar to that of primary appendicitis and likely requires surgical revision of the appendiceal stump or removal of retained tissue		*Treatment similar to that of primary appendicitis and likely requires surgical revision of the appendiceal stump or removal of retained tissue
	*Delay in diagnosis and treatment can result in perforation and sepsis		*Delay in diagnosis and treatment can result in perforation and sepsis



Line 212:		Line 229:

	*[[Special:MyLanguage/Appendicitis (Peds)\|Appendicitis (Peds)]]		*[[Special:MyLanguage/Appendicitis (Peds)\|Appendicitis (Peds)]]



Line 219:		Line 237:
	*[https://www.acep.org/patient-care/clinical-policies/appendicitis/ ACEP Clinical Policy Statement]		*[https://www.acep.org/patient-care/clinical-policies/appendicitis/ ACEP Clinical Policy Statement]
	*[http://www.emdocs.net/appendicitis-why-do-we-miss-it-and-how-do-we-improve/ emDocs - Appendicitis: Why Do We Miss It, and How Do We Improve?]		*[http://www.emdocs.net/appendicitis-why-do-we-miss-it-and-how-do-we-improve/ emDocs - Appendicitis: Why Do We Miss It, and How Do We Improve?]

FuzzyBot: Updating to match new version of source page

2026-01-06T21:16:01Z

Updating to match new version of source page

New page

<languages/>

{{Adult top}}
[[Special:MyLanguage/appendicitis (peds)|appendicitis (peds)]]

==Background==

[[File:Appendix locations.png|thumb|Drawing of colon with variability of appendix locations as seen from anterior view.]]
*Acute inflammation of the vermiform appendix
*Most common non-obstetric surgical emergency in pregnancy
*Most common abdominal surgical emergency in patients <50
*Most common between 10-30 years, but no age is exempt
*Most commonly caused by luminal obstruction by a fecalith
*There are no historical or physical exam findings that can definitively rule out appendicitis

==Clinical Features==

[[File:McBurney's point.jpg|thumb|Location of McBurney's point (1), located two thirds the distance from the umbilicus (2) to the right anterior superior iliac spine (3).]]

===History===

*Early on primarily malaise, indigestion, anorexia
**Later patient develops [[Special:MyLanguage/abdominal pain|abdominal pain]]
***Initially vague, periumbilical (visceral innervation)
***Later migrates to McBurney point (parietal innervation)
*** <50% of patients have this typical presentation
*[[Special:MyLanguage/Nausea|Nausea]], with or with out emesis, typically follows onset of pain
*[[Special:MyLanguage/Fever|Fever]] may or not occur
*Urinary symptoms common given proximity of appendix to urinary tract (sterile pyuria)
*Sudden improvement suggests perforation
*33% of patients have atypical presentation
**Retrocecal appendix can cause [[Special:MyLanguage/flank pain|flank]] or [[Special:MyLanguage/pelvic pain|pelvic pain]]
**Gravid uterus sometimes displaces appendix superiorly → [[Special:MyLanguage/RUQ pain|RUQ pain]]

===Physical Exam===

*McBurney's: maximal tenderness to palpation 2/3 of the way between umbilicus and right anterior superior iliac spine
*Rovsing sign (palpation of LLQ worsens RLQ pain)
*Psoas sign (extension of right leg at hip while patient lies on left side elicits abdominal pain)
*Obturator sign (internal and external rotation of thigh at hip elicits pain
*[[Special:MyLanguage/Peritonitis|Peritonitis]] suggested by:
**Right heel strike elicits pain
**Guarding
**Rebound
**Rigidity

===Clinical Examination Operating Characteristics===

{| class="wikitable"
|-
| Procedure
| LR+
| LR-
|-
| RLQ pain
| 7.3-8.4
| 0-0.28
|-
| Rigidity
| 3.76
| 0.82
|-
| Migration
| 3.18
| 0.50
|-
| Pain before vomiting
| 2.76
| NA
|-
| Psoas sign
| 2.38
| 0.90
|-
| Fever
| 1.94
| 0.58
|-
| Rebound
| 1.1-6.3
| 0-0.86
|-
| Guarding
| 1.65-1.78
| 0-0.54
|-
| No similar pain previously
| 1.5
| 0.32
|-
| Anorexia
| 1.27
| 0.64
|-
| Nausea
| 0.69-1.2
| 0.70-0.84
|-
| Vomiting
| 0.92
| 1.12
|}

==Differential Diagnosis==

{{Abd DDX RLQ}}

==Evaluation==

[[File:Appendicitis_Jarrett_Subramaniam.gif|thumbnail|Dilated, non-compressible appendix with appendicolith and surrounding free fluid<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]
[[File:AppendicitisMark.png|thumb|Peri-appendiceal fat stranding in the setting of acute appendicitis.]]
[[File:X-ray showing fecalith which has caused appendicitis.jpg|thumb|Fecalith (arrow) and stranding in the setting of acute appendicitis.]]
[[File:CAT scan demonstrating acute appendicitis.jpg|thumb|Dialated appendix and stranding in the setting of acute appendicitis.]]

===Appendicitis Risk Scores===

{{Alvarado scoring system}}

===Labs===

*Abdominal panel
**CBC
***Normal WBC does not rule-out appendicitis
***Only 80% of patients will have leukocytosis with left shift<ref>Khan MN, Davie E, Irshad K. The role of white cell count and C-reactive protein in the diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2004;16(3):17-19.</ref>
**Chemistry
**Consider LFTs + lipase
**Consider coagulation studies (PT, PTT, INR), as a marker of liver function
*Urine pregnancy
*[[Special:MyLanguage/Urinalysis|Urinalysis]]
**Leukocytes will be present in 40% of patients<ref>Baird DLH, Simillis C, Kontovounisios C, Rasheed S, Tekkis PP. Acute appendicitis. BMJ. 2017;357:j1703. Published 2017 Apr 19. doi:10.1136/bmj.j1703</ref>
*Consider [[Special:MyLanguage/serum lactate|serum lactate]]
**Does not necessarily define level of severity (if appendicitis is present.)
**Can aid in trending effective resuscitation once the diagnosis is made.
*Consider CRP
**Normal CRP AND WBC makes appendicitis unlikely

===Imaging===

*Early surgical consultation should be obtained before imaging in straightforward cases
*Not universally necessary; consider in:
**Women of reproductive age
**Men with equivocal presentation
*Perforation may result in false negative study
*Imaging modalities
**[[Ultrasound: Abdomen|Ultrasound]]
***First choice for pregnant women and children
***Limitations: operator-dependent, difficult to visualize with obesity, gravid uterus, bowel gas, guarding, lack of patient cooperation
***Findings: noncompressible appendix >6mm in diameter, wall thickness greater or equal to 3 mm
***Other supportive findings: aperistalsis, distinct wall layers, target appearance in axial view, appendicolith, periappendiceal fluid, prominent echogenic periappendiceal fat
**CT
***First choice for adult males and nonpregnant women with equivocal cases
***Women derive the greatest benefit from preoperative imaging (lower neg appy rate)
***Contrast (both PO and IV) is unnecessary but typically ordered
**MRI
***When unable to identify appendix in children or pregnant women

==Management==

===Supportive Management===

#NPO status
#[[Special:MyLanguage/Fluid resuscitation|Fluid resuscitation]]
#[[Special:MyLanguage/Analgesia|Analgesia]]/[[Special:MyLanguage/antiemetics|antiemetics]]

===[[Special:MyLanguage/Antibiotics|Antibiotics]]===

{{Appendicitis Antibiotics}}

===Surgery===

*Open laparotomy or laparoscopy
**Patients who present <72 hours after the onset of symptoms usually undergo immediate appendectomy
**Patients who present >72hrs and have perforated appendix may be treated initially with antibiotics, intravenous fluids, and bowel rest

==Disposition==

*Admission

==Complications==

===Infection===

*Either a simple wound infection or an intraabdominal abscess
**Typically in patients with perforated appendicitis

===Recurrent appendicitis===

*Occurs in approximately 1:50,000 appendectomies <ref>Hendahewa R. et al. The dilemma of stump appendicitis - a case report and literature review. Int J Surg Case Rep. 2015; 14: 101-3.</ref>
*Typically caused by inflammation of the remaining appendiceal stump
**Can also be caused by a retained piece of the appendix not removed during surgery <ref>Boardman T. et al. Recurrent appendicitis caused by a retained appendiceal tip: A case report. The Journal of Emergency Medicine. 2019; 57: 232-4.</ref>
*Can present similar to primary appendicitis
*Treatment similar to that of primary appendicitis and likely requires surgical revision of the appendiceal stump or removal of retained tissue
*Delay in diagnosis and treatment can result in perforation and sepsis

==See Also==

*[[Special:MyLanguage/Appendicitis (Peds)|Appendicitis (Peds)]]

==External Links==

*[http://www.chop.edu/clinical-pathway/appendicitis-without-known-gi-disease-clinical-pathway CHOP Appendicitis Pathway]
*[https://www.acep.org/patient-care/clinical-policies/appendicitis/ ACEP Clinical Policy Statement]
*[http://www.emdocs.net/appendicitis-why-do-we-miss-it-and-how-do-we-improve/ emDocs - Appendicitis: Why Do We Miss It, and How Do We Improve?]

==References==

<references/>
[[Category:GI]]
[[Category:Surgery]]
[[Category:ID]]