Appendicitis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Patients with appendicitis commonly present with pain near the navel that eventually localizes to the right iliac fossa, loss of appetite, fever, nausea, and vomiting.

Common Symptoms

Symptoms of acute appendicitis can be classified into two types: typical and atypical (Hobler, K., 1998).

Typical Symptoms

Typical symptoms may include:

• Pain starting centrally ( in the periumbilical region) before localizing to the right iliac fossa (the lower right side of the abdomen)
  • This is due to the poor localizing (spatial) property of visceral nerves from the mid-gut, followed by the involvement of somatic nerves (parietal peritoneum) as the inflammation progresses.
• Loss of appetite
• Fever may occur
• Nausea may occur
• Vomiting may occur

With the typical presentation of appendicitis the diagnosis of the disease is easier to make, surgery occurs earlier and findings are often less severe (Hobler, K., 1998).

Less Common Symptoms

Appendicitis presenting with atypical symptoms is more difficult to diagnose than with typical symptoms. CT scans and ultrasound is more useful in the diagnosis of the disease when these atypical symptoms present. Surgical findings (suppuration, abscess, perforation, etc.) are more apt to be severe in cases presenting with these symptoms (Hobler,K., 1998).

Atypical Symptoms

Atypical symptoms may include:

• Pain beginning and staying in the right iliac fossa
• Diarrhea
• A more prolonged, smoldering course.
• Increased frequency of urination
  • This occurs when the inflamed appendix lies in contact with the bladder.
• With a post-ileal appendix, marked retching may occur

Alvarado Score

The Alvarado score is the most widely used scoring based system in making a diagnosis of appendicitis. A number of clinical and laboratory based scoring systems have been devised to assist the diagnosis of appendicitis. The most widely used is the Alvarado score:

Alvarado score

Migratory right iliac fossa pain	1 point
Anorexia	1 point
Nausea and vomiting	1 point
Right iliac fossa tenderness	2 points
Rebound tenderness	1 point
Fever	1 point
Leukocytosis	2 points
Shift to left (segmented neutrophils)	1 point
Total score	10 points

A score of 7 or more is strongly predictive of acute appendicitis.
In patients with an equivocal score of 5-6, CT scan further reduces the rate of negative appendectomy.