Appendicitis: Recognize Symptoms and Act Fast

Appendicitis is a surgical emergency. Delayed treatment risks perforation, peritonitis, sepsis, and death.

Classic Presentation

• Periumbilical pain → migrates to RLQ (McBurney's point) over 12–24 hrs.
• Anorexia (near 100%), nausea/vomiting (after pain onset).
• Low-grade fever (37.5–38.5°C), tenderness at McBurney's, rebound, guarding.
• Rovsing's sign (LLQ pressure → RLQ pain), psoas/obturator signs.

Atypical Presentations

• Retrocecal appendix: flank/back pain, less abdominal tenderness.
• Pelvic appendix: suprapubic pain, urinary symptoms, diarrhea.
• Pregnancy: appendix displaced upward; pain may be RUQ/flank.
• Elderly/immunocompromised: muted symptoms, higher perforation rate.

Critical Do's and Don'ts

• DO: Go to ER immediately. NPO for surgery. IV fluids, antibiotics.
• DON'T: Take analgesics (may mask exam), laxatives/enemas (↑ perforation risk), eat/drink, apply heat.

Diagnosis & Treatment

• Clinical + labs (leukocytosis, ↑ CRP) ± CT (sensitivity 95%) or US (kids/pregnant).
• Laparoscopic appendectomy (gold standard); antibiotics alone for select uncomplicated cases (controversial).

Time is appendix. When in doubt, cut it out.