What symptoms are helpful in evaluating for appendicitis?
- It is decidedly uncommon for acute appendicitis to present with nausea, vomiting, or diarrhea before abdominal pain.
- Usually acute appendicitis is heralded by pain and often followed by anorexia, nausea, and sometimes single-episode vomiting.
- Acute appendicitis should be first on the differential diagnosis list in any patient with acute abdominal pain without a prior history of appendectomy.
- A simple scoring system of clinical parameters and laboratory tests, the Alvarado score, has been validated to be very predictive of acute appendicitis.
Alvarado Score
| Symptoms | Score |
|---|---|
| Migration of pain to right iliac fossa | 1 |
| Anorexia | 1 |
| Nausea and vomiting | 1 |
| Signs | |
|---|---|
| Raised temperature, > 37.3° C | 1 |
| Rebound pain | 1 |
| Tenderness in the right iliac fossa | 2 |
Laboratory Findings
Elevated leukocyte counts 2
Neutrophil left shift (> 75%)1
Total 10
Score = 5-6 possible appendicitis
Score = 7-8 probable appendicitis
Score = 9-10 very probable appendicitis
