Migratory Right Iliac Fossa Pain
Classic early symptom pattern of acute appendicitis onset.
- 1: Points awarded (MANTRELS criterion)
- Moderate: Sensitivity (placeholder figure)
- Hours: Typical onset (periumbilical to RIF)
- Visceral→somatic: Mechanism (placeholder note)
Why pain migrates
Short placeholder explaining visceral-to-parietal pain migration pattern.
Placeholder: migratory pain is the single most predictive symptom.
Anorexia, Nausea and Vomiting
Common accompanying symptoms scored as separate criteria.
- 1+1: Points awarded (anorexia, nausea/vomiting)
- ~70-80%: Prevalence (placeholder figure)
- After pain onset: Order (placeholder note)
- Low alone: Specificity (placeholder note)
Symptom scoring
Short placeholder describing anorexia and nausea/vomiting scoring rules.
Placeholder: these symptoms alone are nonspecific but additive.
Fever and Rebound Tenderness
Peritoneal irritation signs raise suspicion of progression.
- 2+1: Points awarded (tenderness, rebound, fever)
- ≥37.3°C: Fever threshold (placeholder figure)
- Blumberg sign: Rebound test (placeholder note)
- Highest single: Weight in score (RIF tenderness = 2pts)
Examining for peritonism
Short placeholder describing rebound tenderness and fever assessment.
Placeholder: RIF tenderness carries the most weight in the score.
Leukocytosis and Left Shift
Laboratory criteria complete the ten-point scale.
- 2+1: Points awarded (leukocytosis, left shift)
- >10,000/µL: WBC threshold (placeholder figure)
- >75% neutrophils: Left shift (placeholder note)
- 3 points: Lab max (of total 10)
Lab criteria
Short placeholder describing leukocytosis and neutrophil left shift.
Placeholder: labs add up to 3 of the 10 total points.
Total Score Interpretation and Action
Score guides discharge, observation, or surgical referral.
- Low risk: Score 1-4 (placeholder figure)
- Equivocal: Score 5-6 (image/observe)
- High risk: Score 7-10 (surgical consult)
- 10: Max score (MANTRELS total)
Using the total score
Short placeholder describing triage decisions by score band.
Placeholder: score ≥7 typically warrants surgical evaluation.