Snapshot A 17-year-old boy is brought to the emergency room by his parents for increasing abdominal pain. He started having periumbilical pain last night but now reports increasing right lower quadrant pain. He reports that about an hour ago, the pain acutely intensified and was not responsive to ibuprofen or acetaminophen anymore. On physical exam, his abdomen is rigid with involuntary guarding and tenderness to light percussion. A right lower quadrant ultrasound shows an enlarged appendix with possible perforation. He is emergently taken to the operating room. Introduction Overview login to view 2 more bullets Epidemiology login to view 14 more bullets Pathogenesis login to view 4 more bullets Presentation Symptoms login to view 5 more bullets Physical exam login to view 9 more bullets Imaging Chest radiograph login to view 4 more bullets Abdominal radiograph login to view 4 more bullets Abdominal ultrasound login to view 6 more bullets CT abdomen and pelvis login to view 2 more bullets Studies Serum labs login to view 11 more bullets Differential Differential by Location of Abdominal PainGeneralizedBowel obstructionMesenteric ischemiaRight Upper QuadrantEpigastricLeft Upper QuadrantAcute cholecystitisHepatitisLiver abscessAcute cholangitisPeptic ulcer diseaseMyocardial infarctionPancreatitisGastric ulcerSplenic ruptureRight Lower QuadrantPeriumbilicalLeft Lower QuadrantAppendicitisBowel obstructionAppendicitisAbdominal aortic aneurysmDiverticulitisLower abdomenInguinal herniaIBDUTIPelvic inflammatory diseaseEctopic pregnancyTesticular torsion Treatment Management approach login to view 1 more bullet Medical login to view 11 more bullets Surgical login to view 3 more bullets Complications Septic shock Death