Generally occurs from obstruction of the appendiceal lumen by lymphoid hyperplasia or a fecalith. Clinical Presentation History. Classic history is that of periumbilical or epigastric pain that migrates to right lower quadrant. Anorexia, nausea, and vomiting occur after the onset of pain. Anorexia is less likely to be present in children.
Presentation is more likely to be atypical in very young, very old, and pregnant patients.
Maintain a high index of suspicion in any patient with abdominal pain. Low-grade temperature is common. High temperature is not common unless perforation has occurred. Abdominal exam should reveal right lower quadrant pain, possibly with rebound or guarding. Rectal exam may reveal localized tenderness but cannot be used to differentiate between those with and those without appendicitis.