Classic presentation for acute appendicitis:
(1) anorexia
(2) abdominal rigidity
(3) pain of short duration
(4) migration of pain to the right lower quadrant
(5) pain centered in the right lower quadrant
(6) right lower quadrant tenderness
where:
• Many physicians use leukocytosis as supporting evidence for the diagnosis. However, leukocytosis should not be used alone to make a therapeutic decision, since it has poor specificity.
• All women of childbearing age should have a pregnancy test performed.
If the patient has a classic presentation, then appendectomy is performed.
If the presentation is equivocal, then an imaging study is performed.
(1) for males and nonpregnant women, CT scan of the lower abdomen (early CT scanning can reduce overall costs vs simple observation)
(2) for pregnant women, ultrasonography of the abdomen.
In women, if a gynecologic disorder is suspected, pelvic and endovaginal ultrasonography should be considered.
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Finding on Imaging Studies
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Action
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compatible with appendicitis
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appendectomy
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appendix not seen
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observe with repeat examination or laparoscopy
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indeterminate results
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observe with repeat examination or laparoscopy
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normal findings
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supportive care
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alternative diagnosis
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appropriate management
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Common conditions in the differential diagnosis for women:
(1) pelvic inflammatory disease
(2) gastroenteritis
(3) urinary tract infection
(4) ruptured ovarian follicle
(5) ectopic pregnancy
