This may be done by an open incision in the abdomen (laparotomy) or through a few smaller incisions with the help of cameras (laparoscopy). Surgery decreases the risk of side effects or death associated with rupture of the appendix. Antibiotics may be equally effective in certain cases of non-ruptured appendicitis. It is one of the most common and significant causes of abdominal pain that comes on quickly. In 2015 about 11.6 million cases of appendicitis occurred which resulted in about 50,100 deaths. In the United States, appendicitis is one of the most common cause of sudden abdominal pain requiring surgery. Each year in the United States, more than 300,000 people with appendicitis have their appendix surgically removed. Reginald Fitz is credited with being the first person to describe the condition in 1886. Signs and symptoms
The presentation of acute appendicitis includes acute abdominal pain, nausea, vomiting, and fever. As the appendix becomes more swollen and inflamed, it begins to irritate the adjoining abdominal wall. This leads to the localization of the pain to the right lower quadrant. This classic migration of pain may not be seen in children under three years. This pain can be elicited through signs, which can feel sharp. Pain from appendicitis may begin as dull pain around the navel. After several hours, pain will usually transition towards the right lower quadrant, where it becomes localized. Symptoms include localized findings in the right iliac fossa. The abdominal wall becomes very sensitive to gentle pressure (palpation).
Typical appendicitis includes several hours of generalized abdominal pain that begins in the region of the umbilicus with associated anorexia, nausea, or vomiting. The pain then "localizes" into the right lower quadrant where the tenderness increases in intensity. It is possible the pain could localize to the left lower quadrant in people with situs inversus totalis. The combination of pain, anorexia, leukocytosis, and fever is classic. Atypical histories lack this typical progression and may include pain in the right lower quadrant as an initial symptom. Irritation of the peritoneum (inside lining of the abdominal wall) can lead to increased pain on movement, or jolting, for example going over speed bumps. Atypical histories often require imaging with ultrasound or CT scanning. Clinical
Aure-Rozanovas sign: Increased pain on palpation with finger in right Petit triangle (can be a positive Shchetkin-Bloombergs). Bartomier-Michelsons sign: Increased pain on palpation at the right iliac region as the person being examined lies on their left side compared to when they lie on their back. Dunphys sign: Increased pain in the right lower quadrant with coughing. Hamburger sign: The patient refuses to eat (anorexia is 80% sensitive for appendicitis)
Kochers (Koshers) sign: From the persons medical history, the start of pain in the umbilical region with a subsequent shift to the right iliac region. Massouh sign: Developed in and popular in southwest England, the examiner performs a firm swish with his or her index and middle finger across the abdomen from the xiphoid process to the left and the right iliac fossa.