GPAtlas🧭 When to suspect
Acute appendicitis is inflammation of the vermiform appendix, usually triggered by luminal obstruction (a faecolith or lymphoid hyperplasia). It is the most common abdominal surgical emergency, with a lifetime risk of around 7–8% and a peak in the second and third decades – though it occurs at any age.
The classic story is vague, central (periumbilical) visceral pain that, over 12–24 hours, migrates to the right iliac fossa (RIF) and becomes sharp, constant and localised as the parietal peritoneum is involved. It is typically accompanied by anorexia, nausea and vomiting (characteristically after the pain begins), and a low-grade fever.
The single most important primary-care skill is recognising that appendicitis is a clinical diagnosis with no confirmatory test in the community: suspect it, then refer for same-day surgical assessment. The second is remembering that the picture is frequently atypical – notably in young children, older people and pregnancy, where delay drives perforation.
| Appendix position | How it can present |
|---|---|
| Anterior / classic | Migratory periumbilical → RIF pain with localised tenderness at McBurney's point. |
| Retrocaecal (commonest position) | Right flank or loin pain, less anterior tenderness – easily mistaken for renal colic or musculoskeletal pain. |
| Pelvic | Suprapubic pain with urinary symptoms or diarrhoea/tenesmus – mimics UTI or gastroenteritis. |
| In pregnancy | Appendix displaced upward by the gravid uterus, so pain is often higher (right flank/upper quadrant); fever and white-cell count are unreliable. |
Source: NHS · RCGP (InnovAiT)
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