Appendicitis, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Most common abdominal emergency

  • Acute obstruction of appendiceal lumen results in distension followed by organ ischemia, bacterial overgrowth, and eventual perforation of the viscus

  • Pa...

Diagnosis

Signs and Symptoms

History

  • Abdominal pain: Primary symptom:

    • Normal location:

      • RLQ pain

      • 35% of patients have appendix located within 5 cm of “normal” location.

    • Retrocecal appendix (28–68%):

      • Back pain

      • ...

Treatment

Initial Stabilization/Therapy

  • Airway, breathing, and circulation management (ABCs)

  • Fluid resuscitation with LR or 0.9% NS

Ed Treatment/Procedures

  • IV fluids, correct electrolyte abnormalities

  • Imme...

Follow-Up

Disposition

Admission Criteria

  • Surgical intervention of acute appendicitis

  • Observation or further diagnostic workup if diagnosis is uncertain

Discharge Criteria

Patients with abdominal pain thoug...

Pearls and Pitfalls

  • Pediatric and geriatric patients present atypically and have increased perforation rates

  • Imaging is not required in a classic presentation of acute appendicitis

  • Appendicitis cannot b...

Additional Reading

  • Basaran  A, Basaran  M. Diagnosis of acute appendicitis during pregnancy: A systematic review. Obstet Gynecol Surv.  2009;64(7):481–488.

  • Hennelly  KE, Bachur  R. Appendicitis up...

Codes

ICD9

  • 540.1 Acute appendicitis with peritoneal abscess

  • 540.9 Acute appendicitis without mention of peritonitis

  • 541 Appendicitis, unqualified

  • 540.0 Acute appendicitis with generalized peritonitis

  • 540 A...

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