Suspect an Appy in patients with new abdominal pain of <1-2 days duration.
Classic Picture (not sensitive; many exceptions):
- Vague upper or periumbilical discomfort with anorexia
- Pain migrates to RLQ and increases
- Nausea, then vomiting & fever
- Then peritonitis
- Focal tenderness to palpation in RLQ, every time you palpate employing varying methods of distraction
- Progressive symptoms over 1-2 days
- NEVER rely on absence of rebound tenderness, Obdurator or Psoas signs to R/O Appy
Patient with low index of suspicion, but very recent onset new pain, consider obtaining a CBC:
- WBC count <10,000 with normal differential speaks against Appy
- OK to send home, F/U in 1 day, with “ER Precautions” if worsens that night
- If goes to ER, must remain n.p.o.