Appendicitis

Condition

More common in children, but can affect anyone.

History

Abdominal pain starting in the umbilicus and moving into the right iliac fossa; may be associated with vomiting, fever, anorexia, and diarrhoea.

Examination

Check temperature. Tender in the RIF with guarding ± rigidity, percussion, and rebound tenderness. Jumping or hopping induces pain (a good test in children). Rovsing sign — pain in the area of maximal tenderness with percussion/palpation of the left lower quadrant. Psoas stretch sign — pain in the right lower quadrant on hip extension. Obturator sign — right lower quadrant pain with flexion and internal rotation of the right hip.

Investigations

FBC (raised leucocytes); CRP (raised) — normal levels do not exclude the diagnosis. Ultrasound in children; CT scan.

Management

If clinical suspicion of appendicitis, refer for ED assessment. Treatment is IV antibiotics and surgical removal of the appendix. If untreated, perforation typically occurs 24–36 hours after pain onset and can lead to complications such as abscess formation, peritonitis, and sepsis.