Appendicitis, Acute

Sarah Dolbear, MD and John Doan, DO Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Acute inflammation of the vermiform appendix

  • Arising from the base of the cecum in right lower quadrant (RLQ), the appendix can be anterior, posterior, medial, lateral to the cecum as...

DIAGNOSIS

  • Diagnosis relies on history and physical examination with supporting laboratory studies and imaging.

  • Scoring systems

    • Modified Alvarado Scoring System (MASS): The use of MASS in the diagnosis...

TREATMENT

GENERAL MEASURES

  • Surgery (appendectomy) has been the standard of care for acute, uncomplicated appendicitis. There is growing evidence for medical management in select cases—this strategy inv...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

  • Return to work in 1 to 2 weeks is typically following most cases of uncomplicated appendicitis.

  • Restrict activity for 4 to 6 weeks after surgery: no heavy lifting ...

REFERENCES

1 Hlibczuk V, Dattaro JA, Jin Z, et al. Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. Ann Emerg Med.  2010;55(1):51.e1–59.e1....

ADDITIONAL READING

  • Di Saverio S, Sibilio A, Giorgini E, et al. The NOTA Study (Non Operative Treatment for Acute Appendicitis): prospective study on the efficacy and safety of antibiotics (amoxicillin...

SEE ALSO

Algorithm: Abdominal Rigidity 

CODES

ICD10

  • K35.80 Unspecified acute appendicitis

  • K35.2 Acute appendicitis with generalized peritonitis

  • K35.3 Acute appendicitis with localized peritonitis

  • K35.89 Other acute appendicitis

  • K35 Acute appendi...

CLINICAL PEARLS

  • Anorexia with periumbilical pain localizing to RLQ is the classic history for acute appendicitis.

  • Diagnosis is more challenging in children, pregnant patients, and the elderly due to va...

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