Appendicitis Updated Review

Typically, the appendicitis illness begins with vague midabdominal discomfort followed by nausea, anorexia, and indigestion. The pain is persistent and continuous but not severe, with occasional mild cramps. There may be an episode of vomiting, and within several hours the pain shifts to the right lower quadrant, becoming localized and causing discomfort on moving, walking, or coughing. The patient may feel constipated.

Examination at this point shows localized tenderness to one-finger palpation and perhaps slight muscular guarding. Rebound or percussion tenderness (the latter provides the same information more humanely) may be elicited in the same area. Peristalsis is normal or slightly reduced. Rectal and pelvic examinations are likely to be negative. The temperature is only slightly elevated (eg, 37.8 °C) in the absence of perforation.