Apendisitis Akut pada Orang Dewasa: Manifestasi Klinis dan Diagnosis

• Acute appendicitis is one of the most common causes of an acute abdomen. The goal of therapy is early diagnosis and prompt operative intervention.
• The position of the appendix can vary significantly between individuals. The appendix can be found in a retrocecal or pelvic location, as well as medial, lateral, anterior or posterior to the cecum. Anatomic variability can complicate the diagnosis as clinical presentation will reflect the anatomic position of the appendix.
• Appendiceal obstruction plays a role in the pathogenesis of appendicitis, but it is not required for the development of appendicitis.
• The "classic" symptoms of appendicitis include right lower quadrant abdominal pain, anorexia, fever, nausea and vomiting. The abdominal pain is initially periumbilical in nature with subsequent migration to the right lower quadrant as the inflammation progresses.
• Not all patients will appendicitis will have the "classic" symptoms. Many patients with appendicitis present with atypical or nonspecific symptoms, such as indigestion, flatulence, bowel irregularity, and generalized malaise. Not all patients will have migratory pain and symptoms can vary depending upon the location of the appendix, especially when the appendix is retrocecal or pelvic.
• The constellation of findings from history, physical examination, and laboratory studies will usually lead an experienced examiner to the correct diagnosis of appendicitis without further imaging. Diagnostic scoring systems can be helpful in the diagnosis of acute appendicitis but cannot definitively rule out the possibility of appendicitis.
• Patients in whom appendicitis is considered to be extremely likely after assessment by an experienced clinician should proceed to appendectomy without further radiologic testing. A diagnostic laparoscopy should be considered for women of child-bearing age as this can help minimize the negative appendectomy rate.
• Diagnostic imaging should be performed when the diagnosis of appendicitis is suspected but unclear.
• A variety of inflammatory conditions in the right lower quadrant can mimic appendicitis and should be considered in differential diagnosis.

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