Assessment and Diagnosis
ÎKey findings for appendicitis obtained from the history, physical examination and white blood cell count are listed in Table 1.
ÎThe physical exam should include auscultation of the lungs, palpation of the abdomen beginning away from the right lower quadrant, and pelvic examination in women.
ÎPain caused by physical examination is to be avoided by using gentle palpation and looking for localized muscular rigidity. doses of narcotics may facilitate the exam.
In some cases small
ÎClinical findings serve to risk-stratify patients and guide decisions about further testing and management. The Alvarado score captures pertinent findings for stratifying patients by probability of disease.
ÎThe Alvarado Scoring System was developed and calibrated on individuals ≥ 16 years of age. It provides probabilities for the presence of appendicitis. Its sensitivity and specificity are inadequate for therapeutic decision- making. It is useful in focusing attention on key signs and symptoms. It may also provide data for local practice audits.
ÎThe Alvarado score is not valid for patients with a palpable mass in the right lower quadrant or with evidence of generalized peritonitis. It is also not useful in patients with sensory impairment due to an acute confusional state, dementia or some other cause.
ÎScores < 5 suggest that the diagnosis of appendicitis is unlikely. Scores of 5 or 6 suggest appendicitis is a possible diagnosis. Scores of 7 or higher support the diagnosis of acute appendicitis.
Table 1. The Alvarado Score (Mnemonic for the diagnostic score of acute appendicitis: MANTRELS)
Symptoms Migration
Anorexia-acetone Nausea-vomiting
Signs
Tenderness in right lower quadrant Rebound Pain
Laboratory Total Score
Elevation of temperature Leukocytosis Shiſt to the leſt
Value 1
1 1 2 1 1 2 1
10
