Nellis Family Medicine Residency Program, Las Vegas, NV, USA.
Saint Louis University Southwest Illinois Family Medicine Residency, Belleville, IL, USA.
Am Fam Physician. 2018 Jul 1;98(1):25-33.
Appendicitis is one of the most common causes of acute abdominal pain in adults and children, with a lifetime risk of 8.6% in males and 6.7% in females. It is the most common nonobstetric surgical emergency during pregnancy. Findings from the history, physical examination, and laboratory studies aid in the diagnosis of acute appendicitis. Right lower quadrant pain, abdominal rigidity, and periumbilical pain radiating to the right lower quadrant are the best signs for ruling in acute appendicitis in adults. Absent or decreased bowel sounds, a positive psoas sign, a positive obturator sign, and a positive Rovsing sign are most reliable for ruling in acute appendicitis in children. The Alvarado score, Pediatric Appendicitis Score, and Appendicitis Inflammatory Response score incorporate common clinical and laboratory findings to stratify patients as low, moderate, or high risk and can help in making a timely diagnosis. Recommended first-line imaging consists of point-of-care or formal ultrasonography. Appendectomy via open laparotomy or laparoscopy is the standard treatment for acute appendicitis. However, intravenous antibiotics may be considered first-line therapy in selected patients. Pain control with opioids, nonsteroidal anti-inflammatory drugs, and acetaminophen should be a priority and does not result in delayed or unnecessary intervention. Perforation can lead to sepsis and occurs in 17% to 32% of patients with acute appendicitis. Prolonged duration of symptoms before surgical intervention raises the risk. In moderate- to high-risk patients, surgical consultation should be accomplished quickly to reduce morbidity and mortality resulting from perforation.
阑尾炎是成人和儿童急性腹痛的最常见原因之一，男性终生风险为 8.6%，女性为 6.7%。它是妊娠期间最常见的非产科外科急症。病史、体格检查和实验室研究结果有助于急性阑尾炎的诊断。右下腹痛、腹部僵硬和脐周疼痛放射至右下象限是成人诊断急性阑尾炎的最佳体征。肠鸣音减弱或消失、腰大肌征阳性、闭孔肌征阳性和 Rovsing 征阳性是儿童诊断急性阑尾炎最可靠的体征。Alvarado 评分、儿科阑尾炎评分和阑尾炎炎症反应评分综合了常见的临床和实验室发现，将患者分为低危、中危或高危，有助于及时诊断。推荐的一线影像学检查包括即时护理或正式超声检查。开腹或腹腔镜阑尾切除术是急性阑尾炎的标准治疗方法。然而，在某些患者中，静脉用抗生素可能被视为一线治疗。疼痛控制应优先考虑阿片类药物、非甾体抗炎药和对乙酰氨基酚，这并不会导致延迟或不必要的干预。穿孔可导致败血症，在 17%至 32%的急性阑尾炎患者中发生。手术干预前症状持续时间延长会增加风险。对于中高危患者，应迅速进行手术咨询，以降低穿孔导致的发病率和死亡率。
