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Appendicitis is a topic covered in the 5-Minute Emergency Consult.

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Emergency Central

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  • Most common abdominal emergency
  • Acute obstruction of appendiceal lumen results in distension followed by organ ischemia, bacterial overgrowth, and eventual perforation of the viscus
  • Pain migration:
    • Periumbilical pain: Appendiceal distension stimulates stretch receptors, which relay pain via visceral afferent pain fibers to 10th thoracic ganglion.
    • RLQ pain: As inflammation extends to surrounding tissues, pain occurs owing to stimulation of parietal nerve fibers and localizes to position of appendix.

Pediatric Considerations
  • 28–57% misdiagnosis in patients <12 yr (nearly 100% in patients <2 yr)
  • 70–90% perforation rate in children <4 yr
  • Perforation correlates strongly with delayed diagnosis.

Geriatric Considerations
  • Decreased inflammatory response
  • 3 times more likely to have perforation owing to anatomic changes
  • Diagnosis often delayed owing to atypical presentations

Pregnancy Considerations
  • Slightly higher rate in 2nd trimester compared to 1st/3rd/postpartum periods
  • Increased perforation rate (25–40%), highest in 3rd trimester
  • RLQ pain remains the most common symptom
  • 7–10% fetal loss, up to 24% in perforated appendicitis


  • Luminal obstruction of appendix
  • Appendiceal lumen becomes distended, inhibiting lymphatic and venous drainage.
  • Bacterial invasion of wall, with edema and blockage of arterial blood flow
  • Perforation and spillage of contents into peritoneal cavity, causing peritonitis (usually 24–36 hr from onset)
  • May wall off and form abscess
  • Gram-negative rods and anaerobic organisms predominate

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Rosen, Peter, et al., editors. "Appendicitis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307384/all/Appendicitis.
Appendicitis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307384/all/Appendicitis. Accessed April 24, 2019.
Appendicitis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307384/all/Appendicitis
Appendicitis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307384/all/Appendicitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Appendicitis ID - 307384 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307384/all/Appendicitis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -