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Gastroenterology
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Suspected Appendicitis
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Imaging tailored to age and pregnancy.
Decision
Outcome
Decision
Modified Alvarado ≥4. Imaging choice?
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Child or pregnant → ultrasound first; if non-diagnostic, MRI (avoid CT radiation)
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Adult, non-pregnant → abdominopelvic CT with contrast
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Skip imaging, go straight to OR
Decision
Imaging result?
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Normal appendix → other diagnosis
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Non-visualized appendix → manage by score, repeat imaging, or surgical evaluation
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Non-perforated appendicitis → antibiotics + appendectomy <12 h
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Perforated → antibiotics + bowel rest; PCD (contained abscess) vs I&D + appendectomy (diffuse contamination)
Outcome
Look for alternative cause (mesenteric adenitis, ovarian pathology, diverticulitis)
Outcome
Management depends on Alvarado score and clinical picture
Outcome
Laparoscopic appendectomy + perioperative antibiotics
Outcome
IV antibiotics, bowel rest, possible drainage; interval appendectomy in 6–8 weeks if managed non-op
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