How does pregnancy affect the clinical presentation of appendicitis?

Updated: Jul 23, 2018
  • Author: Sandy Craig, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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The incidence of appendicitis is unchanged in pregnancy relative to the general population, but the clinical presentation is more variable than at other times.

During pregnancy, the appendix migrates in a counterclockwise direction toward the right kidney, rising above the iliac crest at about 4.5 months' gestation. RLQ pain and tenderness dominate in the first trimester, but in the latter half of pregnancy, right upper quadrant (RUQ) or right flank pain must be considered a possible sign of appendiceal inflammation.

Nausea, vomiting, and anorexia are common in uncomplicated first trimester pregnancies, but their reappearance later in gestation should be viewed with suspicion.

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