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Sections Inflammation of Vermiform Appendix
Overview
Presentation
Workup
Treatment
Guidelines
References

Presentation

History

Abdominal pain is the most common symptom of appendicitis and is present in nearly every patient with this condition. The classic presentation of a patient with appendicitis includes a history of initial periumbilical or epigastric abdominal pain migrating to the right lower quadrant (RLQ). The pain is gradual in onset and progressively worsens. Anorexia, nausea, and vomiting are typically associated with the disease.

The symptoms of appendicitis vary, depending on the location of the appendix. When the appendix is located anteriorly, the classic migratory pain is expected. In patients with a retrocecal appendix, however, a dull ache is often described. When the tip of the appendix is located in the pelvis, atypical pain is commonly encountered. Patients may report dysuria and urinary frequency due to the inflamed appendix irritating the bladder. Patients may also have diarrhea or tenesmus if the inflamed appendix is adjacent to the rectum.

In early appendicitis, the patient is initially afebrile or has a low-grade fever. Higher fevers are associated with a perforated appendix.^[3]

Physical Examination

On physical examination, the patient is usually lying still; movement worsens the pain. Having the patient cough elicits localized pain in the RLQ. Local tenderness to palpation is usually observed. Percussion tenderness is also noted in this area. Children often have localized pain with walking and jumping. The Rovsing sign (pain in the RLQ during palpation of the left lower quadrant [LLQ]) has also been associated with appendicitis. This finding represents indirect tenderness due to peritoneal irritation localized to the RLQ.

Unfortunately, only 55% of patients with appendicitis present with the classic history and physical findings. This is because the early signs and symptoms are primarily dependent on the location of the tip of the appendix, which is highly variable.^[6]

When the tip of the appendix is retrocecal, tenderness may be manifested by passive extension of the hip (psoas sign). When it is located in the pelvis, tenderness may be detected during rectal examination or pelvic examination. Thus, in patients with persistent abdominal pain and rectal symptoms (diarrhea or tenesmus), it is important to perform a rectal examination. If the appendix is lying adjacent to the obturator internus, pain may be manifested with flexion of the right hip and internal rotation. Testicular examination findings are typically normal.

Workup

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Author

Steven L Lee, MD Chief of Pediatric Surgery, Harbor-UCLA Medical Center; Associate Clinical Professor of Surgery and Pediatrics; University of California, Los Angeles, David Geffen School of Medicine

Steven L Lee, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, International Pediatric Endosurgery Group, Pacific Association of Pediatric Surgery, Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Veronica F Sullins, MD Resident Physician, Department of Surgery, Harbor-UCLA Medical Center

Veronica F Sullins, MD is a member of the following medical societies: American College of Surgeons, American Pediatric Surgical Association

Disclosure: Nothing to disclose.

Jeffrey J Du Bois, MD Chief of Children's Surgical Services, Division of Pediatric Surgery, Kaiser Permanente, Women and Children's Center, Roseville Medical Center

Jeffrey J Du Bois, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, California Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

John Geibel, MD, MSc, DSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow; Fellow of the Royal Society of Medicine

John Geibel, MD, MSc, DSc, AGAF is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Additional Contributors

Brian J Daley, MD, MBA, FACS, FCCP, CNSC Professor and Program Director, Department of Surgery, Chief, Division of Trauma and Critical Care, University of Tennessee Health Science Center College of Medicine

Brian J Daley, MD, MBA, FACS, FCCP, CNSC is a member of the following medical societies: American Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma, Southern Surgical Association, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, Tennessee Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Shant Shekherdimian, MD, MPH Resident Physician, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine

Disclosure: Nothing to disclose.

Sections Inflammation of Vermiform Appendix
Overview
Presentation
Workup
Treatment
Guidelines
References

Inflammation of Vermiform Appendix Clinical Presentation

History

Physical Examination

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Inflammation of Vermiform Appendix Clinical Presentation

History

Physical Examination

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