Editing Appendicitis (section)

== '''Presentation''' ==

* '''Classic     order of symptoms'''
** Pain
** Anorexia/nausea/vomiting
** Tenderness
** Fever
** Leucocytosis
* '''Atypical     presentations'''
** Retrocaecal appendix - often      subtle signs with more flank tenderness
** Pelvic appendix - suprapubic      pain suggestive of UTI
** Chronic appendicitis -      plausible for symptoms to wax and wane spontaneously
* Pain (migratory)
** Stretch of visceral afferent      fibres due to appendiceal distension, resulting in initial vague      epigastric or periumbilical pain
** Once inflammation involves      appendiceal serosa, the visceral peritoneum becomes involved and pain      localises to RIF
* Vomiting/nausea/anorexia
** Starting AFTER the pain
* Local tenderness
** Can take some time to      develop
** However you really do need      tenderness to diagnose
** McBurney's point (one third      of the distance between ASIS and umbilicus)
** More diffuse      tenderness/peritonitis is suggestive of perforation
* Hyperesthesia
** T10-T12 on the right
* Rigidity
** Can be absent prior to      perforation
* Fever
** Develops some hours after      pain
** If early high fevers are      present, consider alternatives
* Leucocytosis
* Constipation or diarrhoea may     or may not be present
* Perforation - high fevers,     high WCC, diffuse tenderness/peritonitis, systemic sepsis