Acute Appendicitis: History
Variations in the position of the appendix, age of the patient, and degree of inflammation make the clinical presentation of appendicitis very inconsistent.
The classic history of anorexia and periumbilical pain followed by nausea, right lower quadrant (RLQ) pain, and vomiting occurs in only 50% of cases. Nausea is present in 61-92% of patients. Anorexia is present in 74-78% of patients. |
EtiologyPathophysiologyHistoryPhysical ExaminationInvestigationsDifferential DiagnosisManagementClinical Scenarios |
The most common symptom of appendicitis is abdominal pain. Typically, symptoms begin as periumbilical or epigastric pain migrating to the right lower quadrant (RLQ) of the abdomen.
This pain migration is the most discriminating feature of the patient's history, with a sensitivity and specificity of approximately 80%, a positive likelihood ratio of 3.18, and a negative likelihood ratio of 0.5.
An inflamed appendix near the urinary bladder or ureter can cause irritative voiding symptoms and hematuria or pyuria.
This pain migration is the most discriminating feature of the patient's history, with a sensitivity and specificity of approximately 80%, a positive likelihood ratio of 3.18, and a negative likelihood ratio of 0.5.
An inflamed appendix near the urinary bladder or ureter can cause irritative voiding symptoms and hematuria or pyuria.