# Acute Appendicitis

This is the single most common surgical emergency and you will see plenty of appendicitis during your times on call. That is not to say that it an easy diagnosis to reach. There is no ‘test’ for appendicitis (other than histology!) and we get the diagnosis wrong around 40% of the time.

• Central colicky abdominal pain moving to right illiac fossa and becoming constant
• Anorexia
• Nausea + vomiting
• Low grade fever (37.5-38.5°C)
• Diarrhoea or constipation may occur
• Localised tenderness, guarding, rebound/percussion tenderness (peritonitic)
• Tenderness over McBurney’s point - tenderness over point 1/3 of the way from anterior superior illac spine to umbillicus
• Rovsing’s sign may be positive - palpation in LIF produces pain in the RIF

• Bloods – Grp and save + Clotting (For possible theatre later) FBC, U+Es, LFTS, CRP. Cultures may be useful if also septic
• Urine dip (Make sure to test B-HCG in women)
• Diagnostic laparoscopy is gold standard – appendicitis should be a predominantly clinical decision

• ABC
• Analgesia
• NBM
• IV fluids
• Abx if perforation likely
• Laparoscopic appendicectomy

• If unsure of diagnosis USS abdomen / TVUSS may be useful tool
• CT Abdo / Pelvis if diagnosis not clear
• Diagnostic laparoscopy