GuidelinesOther guideline
Acute Appendicitis
This booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.
Diagnosis
- Central abdominal pain moving to the right iliac fossa (RIF) is typical
- Nausea & vomiting are more frequent with appendicitis than with PID
- Tenderness is usually localized to the RIF, with rebound
- Positive Rovsing’s sign – pressing on the left & asking if the pain is more on the right; in PID the tenderness remains left-sided
- Psoas sign – pain caused by downward pressure on the patient’s flexed right knee; it is positive in retrocaecal or pelvic appendicitis
- Fetor – although nonspecific, it is associated with appendicitis rather than PID
- Cervical excitation is less than expected for PID
Investigations
- Ultrasound scan: the inflamed appendix is said to appear as a target if seen in transverse section. The surgeons will ask for a CT scan
- Abdominal X-ray may be helpful (‘sentinel loop’ of bowel)
- FBC & U&E
- CRP if there is doubt about inflammation
Management
- Call for a general surgical opinion
- If the surgeons do not consider appendicitis to be likely & the patient seems to require laparotomy proceed with the operation & let the surgeons know you are doing so