What are the symptoms of appendicitis?
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Symptoms of Appendicitis: A Comprehensive Overview
Common Symptoms of Appendicitis
Abdominal Pain in Appendicitis
Abdominal pain is the hallmark symptom of appendicitis. Typically, the pain begins in the central abdomen or periumbilical region and then migrates to the right lower quadrant (RLQ) within 1-12 hours1 3 7. This pain is often described as dull and aching initially but becomes sharper and more localized as the condition progresses2 8.
Gastrointestinal Symptoms: Nausea, Vomiting, and Anorexia
Nausea, vomiting, and loss of appetite (anorexia) are frequently associated with appendicitis. These symptoms can vary in intensity but are commonly present in most cases3 4 7.
Fever and Rigidity
Low-grade fever often accompanies appendicitis, and as the condition worsens, patients may experience abdominal rigidity and localized tenderness in the RLQ1 4 7.
Atypical Symptoms of Appendicitis
Variability in Pain Location
In some cases, the pain may not follow the classic pattern and can be felt anywhere in the abdomen, back, or rectum. This variability can lead to diagnostic confusion2 4.
Urinary and Gastrointestinal Symptoms
Atypical presentations may include painful urination, bloating, flatulence, and generalized abdominal tenderness. Some patients may also experience constipation or diarrhea2.
Absence of Typical Symptoms
In rare instances, patients may not exhibit the classic symptoms of appendicitis, such as pain, nausea, vomiting, or fever. This can make diagnosis particularly challenging2.
Diagnostic Signs and Scoring Systems
Physical Examination Signs
Several physical examination signs are useful in diagnosing appendicitis. These include:
- Right Lower Quadrant Pain: A key indicator in adults1.
- Positive Psoas Sign: Pain on extension of the right thigh, indicating irritation of the iliopsoas muscle1.
- Positive Obturator Sign: Pain on internal rotation of the flexed right thigh, suggesting irritation of the obturator internus muscle1.
- Positive Rovsing Sign: Pain in the RLQ upon palpation of the left lower quadrant1.
Scoring Systems
Scoring systems like the Alvarado score, Pediatric Appendicitis Score, and Appendicitis Inflammatory Response score incorporate clinical and laboratory findings to stratify patients by risk and aid in diagnosis1.
Conclusion
Appendicitis presents with a range of symptoms, from the classic abdominal pain migrating to the right lower quadrant, nausea, vomiting, and fever, to atypical presentations that can complicate diagnosis. Recognizing the variability in symptoms and utilizing physical examination signs and scoring systems can aid in timely and accurate diagnosis, reducing the risk of complications such as perforation and sepsis.
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Most relevant research papers on this topic
Acute Appendicitis: Efficient Diagnosis and Management.
Effective diagnosis and management of acute appendicitis requires history, physical examination, and laboratory studies, with early surgical intervention in moderate- to high-risk patients.
Highly CitedAtypical Presentations of Appendicitis
Atypical symptoms of appendicitis often misguide primary care physicians and surgeons, resulting in failure to diagnose the condition early, potentially leading to life-threatening complications.
US diagnosis of acute appendicitis
Acute appendicitis is diagnosed by evaluating anorexia, nausea, vomiting, and pain, with a sensitivity of 80% and specificity of 80% in the right lower quadrant.
Diagnosis of acute appendicitis.
Advances in imaginology have improved the diagnosis of acute appendicitis, but despite these advances, the diagnosis remains a challenge due to atypical presentations and varying clinical symptoms.
Case ReportHighly CitedAppendicitis in pregnancy.
Accurate diagnosis of appendicitis in pregnancy requires high suspicion and clinical skills, not just classic signs and diagnostic testing, to reduce negative maternal and fetal outcomes.
Systematic ReviewHighly CitedTHE NATURE OF THE SYMPTOMS IN APPENDICITIS
Appendicitis symptoms arise from increased energy passing through sympathetic nerves, affecting neighboring nerve cells and causing symptoms based on their function.
Diagnosis and Management of Acute Appendicitis in Adults: A Review.
Appendectomy remains the first-line treatment for acute appendicitis, but antibiotics can effectively treat uncomplicated cases in 70% of patients.
Literature ReviewHighly CitedWSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis
The WSES Jerusalem guidelines provide comprehensive clinical guidelines for diagnosing and managing acute appendicitis, focusing on diagnostic efficiency, imaging, non-operative treatment, timing of appendectomy, surgical treatment, and antibiotics.
Rigorous JournalHighly CitedAcute appendicitis in late adulthood: incidence, presentation, and outcome. Results of a prospective multicenter acute abdominal pain study and a review of the literature
Late adult acute appendicitis is associated with delayed treatment, high perforation rates, and unfavorable outcomes, making older patients high-risk and requiring experienced surgeons within a narrow time margin.
Systematic ReviewHighly Cited