Ep 129 – Acute appendicitis

Acute appendicitis remains the most common surgical emergency in childhood and a leading cause of acute abdomen in adults, affecting approximately 10% of the population. Diagnosis typically follows a progression from vague central visceral pain to localized somatic pain in the right iliac fossa, often accompanied by nausea, anorexia, and localized tenderness at McBurney’s point. While clinical assessment is foundational, the Appendicitis Inflammatory Response (AIR) score provides a structured framework for evaluating risk through markers like white cell count, CRP levels, and rebound tenderness. Although ultrasound is preferred for children and pregnant women to avoid radiation, CT scanning offers higher sensitivity for obese patients and indeterminate cases. Surgical appendicectomy remains the gold standard treatment, as antibiotic-only approaches carry a 30% failure rate and significant risk of recurrence. Minimizing diagnostic delay requires careful physical examination, including rectal exams, and avoiding premature narcotic analgesia which can mask critical symptoms.