Snap Shot 24-year-old presents with nausea, vomiting, constipation, and periumbilical pain that settles in the lower right quadrant. On Physical Exam she has tenderness and guarding in the lower right quadrant. Introduction Increased frequency 10-30 years of age More common in US due to low fiber diet Most common etiologies are lymphoid hyperplasia fecolith obstruction Presentation Symptoms loss of appetite, nausea, vomiting fever pain moves from periumbilical area to LRQ diarrhea only with retrocecal appendicitis Physical exam Blumberg sign rebound tenderness at McBurney's point Psoas/Obturator sign raise the patient's right leg with the knee flexed rotate the leg internally at the hip increased abdominal pain indicates a positive obturator sign Rovsing's sign pressure over the descending colon causes pain in the RLQ Evaluation Labs absolute neutrophillic leukocytosis and left shift always perform pregnancy test Physical Exam perform rectal exam, tenderness suggests inflamed posterior appendix Imaging Abdominal US first in pediatric and pregnant patients to spare ionizing radiation Abdominal CT scan in adults or pediatric patients without a diagnostic US Differential PID, ovarian torsion, gyn disorders, volvulus, gastroenteritis, ectopic pregnancy, pyelonephritis, diverticulits, colorectal cancer, IBD, cholecystitis, Meckel's, mesenteric ischemia Treatment Laparoscopic Appendectomy CT guided drainage of abscess Prognosis, Prevention, and Complications Perforation Peritonitis Periappendiceal abscess Pylephlebitis (inflammation of the portal vein) Septicemia