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Acute Appendicitis

Also known as: appendicitis · acute abdomen · RIF pain

Acute inflammation of the appendix — the commonest surgical acute abdomen. Classically peri-umbilical pain that migrates to the right iliac fossa. Prompt surgery prevents perforation.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Any age, peaking in teens and young adults; caused by luminal obstruction (faecolith, lymphoid hyperplasia).

Red flags — escalate / refer

Generalised peritonitis (rigid abdomen, guarding) suggests perforation → urgent surgery.
Sepsis, or an appendix mass/abscess → urgent surgical care.

Work-up / diagnosis

1Mostly clinical: migratory right-iliac-fossa pain, anorexia, low-grade fever, RIF tenderness/rebound (McBurney's point), Rovsing's/psoas signs; a score (e.g. Alvarado) can help.
2Bloods (raised WCC/CRP); urinalysis and a pregnancy test to exclude mimics.
3Ultrasound (children/women) or CT where the diagnosis is unclear.

Management — overview

Refer to surgery; keep nil-by-mouth with IV fluids, analgesia and antiemetics.
Appendicectomy (laparoscopic or open) is the definitive treatment; give perioperative antibiotics.
Perforation/peritonitis: resuscitate, IV antibiotics and urgent surgery.
An appendix mass/abscess may be managed with antibiotics ± drainage, considering interval appendicectomy.

In-depthFull dosing & advanced protocol

Drug dosing

Perioperative / therapeutic antibiotics

Cover Gram-negatives + anaerobes

Adult dose: Broad-spectrum per local guidance (e.g. a cephalosporin + metronidazole)
Route: Intravenous

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

Supportive care

Pre-operative

Adult dose: IV fluids, analgesia and antiemetics
Route: Intravenous

Caution: Analgesia does not mask serious pathology — give it; always exclude pregnancy (ectopic mimic).

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Scoring, mimics & non-operative debate

Scores (e.g. Alvarado) plus imaging refine the diagnosis and reduce negative appendicectomy.
Exclude mimics: ectopic pregnancy, ovarian pathology, mesenteric adenitis, ureteric colic, right-sided diverticulitis.
Selected uncomplicated cases may be treated with antibiotics alone, but recurrence is a risk — individualise.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Acute Cholecystitis & Biliary ColicInflammation of the gallbladder, usually from an obstructing gallstone — constant right-upper-quadrant pain, fever and a positive Murphy's sign. Biliary colic is transient pain from a stone WITHOUT inflammation.Acute Limb IschaemiaSudden loss of arterial perfusion to a limb — a surgical emergency. The 6 Ps: Pain, Pallor, Pulselessness, Paraesthesia, Paralysis and Perishing cold. Muscle and nerve injury begin within hours.Acute Compartment SyndromeRaised pressure within a closed fascial compartment cuts off perfusion — a limb-threatening surgical emergency. Pain out of proportion and pain on passive stretch are the earliest signs; fasciotomy is the treatment.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Perioperative / therapeutic antibiotics

Supportive care

📈 Scoring, mimics & non-operative debate

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Perioperative / therapeutic antibiotics

Supportive care

📈 Scoring, mimics & non-operative debate

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Scoring, mimics & non-operative debate

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Scoring, mimics & non-operative debate

References