Symptoms

1-Abdominal pain is the prime symptom of acute appendicitis. >95%

• Can be in the RLQ, to the pelvis, right flank, RUQ
• intermittent， crampy, abdominal pain in the epigastric or periumbilical region.
• migrates to the right lower quadrant over 1 2-24 h， where it is sharper and can
be definitively localized as transmural inflammation d/t appendix irritating the
parietal peritoneum.

2-Anorexia nearly always accompanies appendicitis. >70%,

- diagnosis of appendicitis should be questioned if absent.

3-Constipation or diarrhea occurs in 4-16% of patients

4-Nausea and vomiting nausea and vomiting occur after
development of abdominal pain, vomit is mild and scant

5-Fever slightly raised,

unless acc. with complications- perforation phlegmon, abcess formation = >38.3°C
Others
dysuria， urinary frequency， diarrhea， or tenesmus,
lying still to avoid peritoneal irritation, discomfort
caused by coughing, sneezing–or similar to Valsava
maneuver
Signs
• Temperature elevation is rarely >1°C

• Pulse rate is normal or slightly elevated

• Tenderness often is maximal at or near the McBurney point

• located approximately one-third of the way along a line originating at the anterior iliac
spine and running to the umbilicus

• Direct/ indirect rebound tenderness

• The Rovsing sign—pain in the right lower quadrant when palpatory pressure is exerted in the
left lower quadrant

• psoas sign - indicates an irritative focus in proximity to that muscle

• obturator sign of hypogastric pain on stretching the obturator internus indicates irritation in the
pelvis. The test is performed by passive internal rotation of the flexed right thigh with the
patient supine.
LABORATORY FINDINGS
• Mild to Mod leukocytosis, 10,000 to 18,000 cells/mm3

• Left shift toward immature poly morphonuclear leukocytes

• Urinalysis is indicated to help exclude genitourinary conditions

 Imaging Studies
1. Graded compression sonography
• inexpensive
• can be performed rapidly does not require a contrast
medium, and can be used even in pregnant patients.
Sonographically, the appendix is identified as a blind-ending,
nonperistaltic bowel loop originating from the cecum.

2. Ultrasonography， especially intravaginal techniques，

• useful for identifyring pelvic pathology in women.
• Ultrasonographic findings suggesting the presence of
appendicitis include wall thickening， an increased
appendiceal diameter，and the presence of free fluid.
Alvarado Scale for the Diagnosis of Appendicitis
Clinical algorithm for suspected cases of acute appendicitis