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

Bottom Line:

  • 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.