Last Updated on August 19, 2026
“The biggest MISTAKE in managing acute appendicitis is to discharge patient from primary care with referral to SOPD as outpatient!”
22 years old male, no known medical illness. He presented with right iliac fossa pain for 2 days.
History Taking
- Typical symptoms: Abdominal pain (right iliac fossa region), diarrhoea, vomiting
- Relevant negative:
Passing flatus
, UTI×
Sign of intestinal obstruction e.g. secondary to obstructed inguinal hernia
symptoms×UTIAbbreviation: UTI
Urinary tract infection
=====
💡Remember
If Urine FEME / Urine dipstick shows feature of UTI (leucocyte positive, nitrite positive), do renal punch to look for sign of pyelonephritis
Physical Examination
-
Vital signs
×
• To look for signs of (septic) shock / sepsis e.g. tachycardia, hypotension, fever
• Pain score: to assess severity of pain -
Abdomen
×
• To look for rebound tenderness / tenderness, especially over right iliac fossa region
• To look for palpable mass -
Renal punch
×
• UTI feature
-
Inguinal hernia examination
×
• To rule out abdominal pain due to obstructed inguinal hernia
• Documentation: Bilateral inguinal orifice intact -
Scrotal examination
×
• To rule out testicular torsion
• Documentation: Bilateral testes palpable
Investigations
-
FBC
×
• WCC: Raised white cell count is seen in acute appendicitis
-
VBG
×
• To look for metabolic acidosis
-
UFEME / Urine dipstick
×
• TRO UTI
-
CXR
-
AXR
×
• Any stone?
• Any dilated bowel?
Diagnosis
- Depending on findings from history taking, physical examination and investigation: Acute appendicitis / Perforated appendicitis / Acute appendicitis TRO perforated appendicitis