• Abdominal pain
• Anorexia, nausea, and vomiting
• Localized right lower quadrant pain
• Low-grade fever
• 7% of people in Western countries have appendicitis at some time in their lives
• 200,000 appendectomies for acute appendicitis are performed each year in the United States
• Incidence in developing countries has been increasing in proportion to economic gains and changes in lifestyle
• Major causes: Obstruction of the proximal lumen by fibrous bands, lymphoid hyperplasia, fecaliths, calculi, or parasites
• Evidence of temporal and geographic clustering of cases has suggested a primary infectious etiology
• Diagnosis is most difficult in the very young or old
• Highest incidence of false-positives occur in women between the ages of 20 and 40, attributable to pelvic inflammatory disease (PID) and other gynecologic conditions
• Classically, abdominal pain develops prior to nausea and vomiting
• Peri-umbilical abdominal pain initially, then localizes to the right lower quadrant
• Right lower quadrant rebound or percussion tenderness (localized "peritoneal irritation")
• Constipation and indigestion are frequent complaints
• Patients complain of discomfort with movement, walking, or coughing
• Low-grade fever (99 °F-101 °F) unless perforation has occurred
• Mild leukocytosis (10,000-15,000) with left shift
• Mild elevations in amylase
• UA frequently will show a few WBC and RBCs on microscopic exam
• Elevated C-reactive protein and ESR levels
• Plain films may show evidence of localized air fluid levels or localized ileus or increased soft-tissue density in the right lower quadrant
• US may demonstrate a dilated tubular structure in the right lower quadrant although this technique is user- and institutional-dependant and is less sensitive in adults than in children
• Spiral CT (either abdominal/pelvic or a dedicated "appendiceal protocol") is the most sensitive and specific diagnostic radiographic test
• Acute salpingitis
• Regional enteritis/complicated Crohn disease
• Viral gastroenterologic infection
• Mesenteric adenitis
• Ovarian lesions
• Urinary tract infections
• Small bowel obstruction
• Cecal volvulus
• Incarcerated hernia
• Mesenteric ischemia
• Acute cholecystitis
• Right-sided diverticulitis (true cecal or a redundant sigmoid that flops over into the right lower quadrant)
• Complicated peptic ulcer disease (with enteric contents collecting in the right paracolic gutter)
• Infarcted epiploic appendage
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