Appendicitis

Background

• Most common nonobstetric surgical emergency in pregnancy
• Most commonly caused by luminal obstruction by a fecalith
• There are no historical or physical exam findings that can definitively rule out appy

Clinical Features

• Early on primarily malaise, indigestion, anorexia
  • Later pt develops abdominal pain
    • Initially vague, periumbilical (visceral innervation)
    • Later migrates to McBurney point (parietal innervation)
• Nausea, w/ or w/o emesis, typically follows onset of pain
• Fever may or not occur
• Urinary symptoms common given proximity of appendix to urinary tract (sterile pyuria)
• Sudden improvement suggests perforation
• 33% of pts have atypical presentation
  • Retrocecal appendix can cause flank or pelvic pain
  • Gravid uterus sometimes displaces appendix superiorly -> RUQ pain

Physical Exam

• Rovsing sign (palpation of LLQ worsens RLQ pain)
• Psoas sign (extension of R leg at hip while pt lies on L side elicits abd pain)
• Obturator sign (internal and external rotation of thigh at hip elicits pain
• Peritonitis suggested by:
  • Right heel strike elicits pain
  • Guarding