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Primary Care Liaison

Acute appendicitis - pre-referral

  • This is an urgent surgical condition.

    Assessment and when to refer

    History and physical examination. There are 3 different classical presentations and 2 further difficult groups.

    1. Shift of pain to RIF with local guarding. +/- fever, anorexia and vomiting.
      • IMMEDIATE REFERRAL to the Emergency Department if guarding is present.
      • Give pain relief and keep fasted. 
        • Please provide history and any investigations undertaken.
    2. Retrocoecal appendix - deep RIF tenderness without guarding. Differentiation from viral mesenteric adenitis can be difficult.
      • If suspected, refer to the Emergency Department.
      • Give pain relief and keep fasted. 
        • Please provide history and any investigations undertaken.
    3. Pelvic appendix - vague lower abdominal pain and tenderness, often with diarrhoea. Often confused with gastroenteritis.
      • If suspected, refer to the Emergency Department.
      • Give pain relief and keep fasted. 
        • Please provide history and any investigations undertaken.
    4. Difficult group <5 years - guarding difficult to elicit. Does not want to walk or be examined.
      • If suspected, refer to the Emergency Department.
      • Give pain relief and keep fasted. 
        • Please provide history and any investigations undertaken.
    5. Difficult group adolescent females - differentiation from ovarian pathology difficult.
      • If suspected, refer to the Emergency Department.
      • Give pain relief and keep fasted. 
        • Please provide history and any investigations undertaken.

    Resources

    References and more reading

    • Paediatric Handbook (2015). Gastrointestinal Conditions, Chapter 24 (pp369-389) Mark Oliver and Lionel Lubitz. Ninth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia.

    Guideline developed by RCH Department of Gastroenterology. First published Jan 2008. Reviewed August 2018.

    Thanks to Consultant Paediatric Surgeon Tom Clarnette for permission to adapt existing guidelines.  Many thanks to the GPs involved in the review. Please read Copyright and Disclaimer.