Episode 138: EBM Acute Appendicitis in Adults Part 1

Acute appendicitis is the most common abdominal surgical emergency worldwide, carrying a lifetime risk of 9% for males and 7% for females. While right lower quadrant pain and migration are classic indicators, atypical presentations occur in one-third of cases, with pregnant patients often experiencing right upper quadrant pain and elderly patients facing perforation rates as high as 70%. Clinical diagnosis relies on specific physical signs like McBurney’s tenderness and the psoas sign, though no single finding can definitively exclude the condition. Laboratory markers including leukocytosis and elevated C-reactive protein lack individual specificity but reach 95% sensitivity when combined. Modern risk stratification favors the Appendicitis Inflammatory Response (AIR) and Adult Appendicitis (AAS) scores over the traditional Alvarado score, as they provide superior accuracy and help reduce negative appendectomy rates and unnecessary imaging in low-risk patients under 40.