Synopsis
Diagnose appendicitis across typical and atypical presentations, identify perforation or sepsis early, and coordinate imaging, antibiotics and surgical source control safely.
- Classic appendicitis begins with poorly localised central abdominal pain that migrates to the right iliac fossa as parietal peritoneum becomes inflamed.
- Anorexia, nausea, low-grade fever and focal guarding support the diagnosis, but their absence does not exclude appendicitis in older adults, pregnancy or immunosuppression.
- Retrocaecal inflammation may cause flank or back pain with little anterior guarding; a pelvic appendix may produce suprapubic pain, diarrhoea or urinary symptoms.
Key red flags
Pain migrates from periumbilical or epigastric discomfort to the right iliac fossa, with anorexia, nausea and focal tenderness near McBurney's point; movement, coughing or percussion may worsen pain.
Investigation priorities
Track localisation, peritonism and physiological deterioration over time.
Management branches
Localised right iliac fossa pain without shock or generalised peritonitis.
- Assess ABCDE, provide analgesia and antiemetic treatment, establish venous access, check hydration and keep the patient nil by mouth pending a surgical decision.
- Obtain blood tests, urinalysis and a pregnancy test where relevant; involve the acute surgical team and document serial examinations rather than relying on one score.
Key medicines
Perioperative antibiotic prophylaxisGive the local appendicectomy prophylaxis regimen within the approved pre-incision window.
Therapeutic broad-spectrum antibioticsUse the local intra-abdominal infection protocol and review after source control.