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.
|Migration of pain to right iliac fossa||1|
|Nausea and vomiting||1|
|Raised temperature, > 37.3° C||1|
|Tenderness in the right iliac fossa||2|
Elevated leukocyte counts 2
Neutrophil left shift (> 75%)1
Score = 5-6 possible appendicitis
Score = 7-8 probable appendicitis
Score = 9-10 very probable appendicitis