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CDHB

Acute Appendicitis

See also Acute Abdominal Pain and Common Emergency Presentations > Abdominal Pain.

History

• Full examination including rectal examination.
• Check for RIF tenderness, rebound guarding, signs of peritonism or peritonitis.
• Fever, tachycardia, oral foetor.

Investigations

• CBC + diff.
• Na, K, creatinine, amylase, LFTs.
• Urinalysis.
• In females, consider obstetric and gynaecological causes. Investigations as appropriate, e.g., pregnancy testing.

Imaging:

• More likely to be helpful if history/signs equivocal and in female patients.
• Abdominal X-ray + pelvic ultrasound.
• Consider MRI/CT - discuss with Consultant.

Management

• Appendicitis: appendicectomy (laparoscopic or open).
  • Prophylactic antibiotics: single doses of gentamicin 2 mg/kg IV and metronizadole 500 mg IV 1 hour pre-op.
  • VTE prophylaxis.
• Appendix mass or abscess: conservative treatment with antibiotics ± radiological drainage:
  • Conservative (medical) treatment including IV antibiotics: IV amoxicillin 1 g q6h, IV gentamicin (refer to the gentamicin/tobramycin dosing guidelines in the Pink Book), and IV metronidazole 500 mg q8h.
  • Clinical review at least twice daily. Check for signs of peritonitis or peritonism and reconsider options.
  • Assess the need for intervention - this is a Consultant decision.
• Appendicitis not confirmed: seek alternate diagnosis.

Discharge:

• When patient is freely mobile.
• Tolerating fluids and food without nausea/vomiting.
• Pain is managed satisfactorily.

• Check need for ongoing antibiotics, analgesia, and clarify follow-up arrangements.

Topic Code: 66068