The clinical presentation suggests acute appendicitis, which requires surgery. Anaesthesia and surgery increase the risk to the fetus. It is therefore important to establish whether a child at this age is pregnant. We are told that she is Gillick competent (https://www.cqc.org.uk/guidance-providers/gps/nigels-surgery-8-gillick-competency-fraser-guidelines). She can therefore decide whether she wants her mother present when you ask confidential questions. Next establish whether she has started her periods, as this can start anywhere between 7-17 years. Consider the possibility of haematocolpos in a young woman who looks sexually mature. Next establish whether she is sexually active. If she is, then consent should be taken from her (if Gillick competent) or from a person with parental responsibility before pregnancy testing of the urine.

[FEthL1] Understand the principles of child advocacy i.e. that all decisions are to be made in the best interest of the child and issues relating to consent and confidentiality.