22/10/2025
Appendicitis
(based on The 5-Minute Clinical Consult 2023)
👉Definition
Acute appendicitis is inflammation of the vermiform appendix, usually caused by luminal obstruction leading to ischemia, bacterial overgrowth, and possible perforation .
👉Symptoms
• Classic sequence: vague periumbilical pain → anorexia, nausea, vomiting → pain localizing to the right lower quadrant (RLQ) within 4–48 hours 
• Associated signs: fever, tenderness at McBurney’s point, rebound tenderness, guarding, and leukocytosis.
• Atypical presentations: more common in children, elderly, and pregnant women.
👉Diagnosis
• Primarily clinical, supported by lab and imaging studies.
-Modified Alvarado Score (MASS):
• RLQ tenderness (2), rebound tenderness (1), leukocytosis (2), fever (1), migratory pain (1), nausea/vomiting (1), anorexia (1)
• Score >7 → likely appendicitis; 4–6 → consider CT 
-Imaging:
• CT scan with contrast – sensitivity 91–98%, specificity 95–99%
• Ultrasound – preferred in pregnancy and pediatrics
• MRI – alternative for contrast allergy or renal failure .
👉Differential Diagnosis
• Gastroenteritis
• Mesenteric adenitis
• Meckel’s diverticulitis
• Ovarian torsion / pelvic inflammatory disease
• Renal colic
• Crohn’s disease
👉Treatment
General measures:
• Appendectomy is the standard of care for acute, uncomplicated appendicitis .
• Nonoperative management: antibiotics may be used in select uncomplicated cases, with ~39% recurrence in 5 years .
Antibiotic therapy:
• Uncomplicated: Cefoxitin or ampicillin/sulbactam; or cefazolin + metronidazole
• Nonoperative regimen: Ertapenem (3 days) → oral levofloxacin + metronidazole (7 days)
• Complicated (perforated/gangrenous): Piperacillin-tazobactam or 3rd-gen cephalosporin + metronidazole .
👉Follow-Up
• Discharge once afebrile, tolerating diet, with normal WBC.
• Return to work: 1–2 weeks post uncomplicated appendectomy.
• Activity restriction: avoid heavy lifting for 4–6 weeks.
• If nonoperative and >40 years: colonoscopy to rule out malignancy .
👉Prognosis
• Excellent if treated early.
• Morbidity: 3% (nonperforated), 47% (perforated)
• Mortality:
