## Clinical Features of Acute Appendicitis ### Classic Presentation **Key Point:** The classic sequence is periumbilical pain → migration to RLQ over 6–12 hours, followed by fever and systemic signs. However, fever timing and degree vary widely. ### Fever in Appendicitis **High-Yield:** Fever in uncomplicated acute appendicitis is typically **low-grade (37.5–38.5°C)**. A high fever (>39°C) suggests **complications** such as: - Perforation - Gangrenous appendix - Peritonitis - Abscess formation Crucially, **absence of fever does NOT exclude appendicitis**, and low-grade fever is common in simple appendicitis. ### Why Option 2 is Incorrect The stem claims fever >39°C is typical of appendicitis. This is **false** — high fever suggests **complicated appendicitis**, not uncomplicated acute appendicitis. Simple appendicitis often presents with low-grade or no fever. ### Correct Features (Options 0, 1, 3) | Feature | Truth | |---------|-------| | Rebound tenderness & guarding | Yes — peritoneal irritation sign | | Pain migration (periumbilical → RLQ) | Yes — occurs in >50% of cases; highly suggestive | | Leukocytosis with left shift | Yes — common but not mandatory; normal WBC does not exclude appendicitis | **Clinical Pearl:** Appendicitis remains a **clinical diagnosis**. Investigations (ultrasound, CT) support but do not replace clinical judgment. A patient with classic history and signs should be operated even with normal WBC. **Warning:** Do not delay surgery waiting for fever to rise or WBC to climb. Early appendicitis may have minimal systemic signs.
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