Appendicitis (cont.)
What are the symptoms of appendicitis?
The main symptom of appendicitis is abdominal pain. The pain is at first
diffuse and poorly localized, that is, not confined to one spot. (Poorly
localized pain is typical whenever a problem is confined to the
small intestine or
colon, including the appendix.) The pain is so difficult to pinpoint that when
asked to point to the area of the pain, most people indicate the location of the
pain with a circular motion of their hand around the central part of their abdomen. A second, common,
early symptom of appendicitis is loss of appetite which may progress to nausea and even
vomiting. Nausea and vomiting also may occur later due to
intestinal obstruction.
As appendiceal inflammation increases, it extends through the appendix to its
outer covering and then to the lining of the abdomen,
a thin membrane called the
peritoneum. Once the peritoneum
becomes inflamed, the pain changes and then can be localized clearly to one
small area. Generally, this area is between the front of the right hip bone and
the belly button. The exact point is named after
Dr. Charles McBurney--McBurney's point. If the appendix ruptures and infection
spreads throughout the abdomen, the pain becomes diffuse again as the entire
lining of the abdomen becomes inflamed.
How is appendicitis diagnosed?
The diagnosis of appendicitis begins with a thorough history and
physical examination. Patients often have an elevated temperature, and there usually
will be moderate to severe tenderness in the right lower abdomen when the
doctor pushes there. If inflammation has spread to the peritoneum, there is
frequently
rebound tenderness. Rebound tenderness is pain that is worse when the doctor quickly releases his hand
after gently pressing on the abdomen over the area of tenderness.
White Blood Cell Count
The white blood cell count in the blood
usually becomes elevated with infection. In early appendicitis, before infection
sets in, it can be normal, but most often there is at least a mild elevation
even early. Unfortunately, appendicitis is not the only condition that causes
elevated white blood cell counts. Almost any infection or inflammation can cause
this count to be abnormally high. Therefore, an elevated white blood cell count
alone cannot be used as a sign of appendicitis.
Urinalysis
Urinalysis is a microscopic examination of the
urine that detects red blood
cells, white blood cells and bacteria in the urine. Urinalysis usually is
abnormal when there is
inflammation or stones in the kidneys or bladder. The urinalysis also may
be abnormal with appendicitis because the appendix lies near the ureter and
bladder. If the inflammation of appendicitis is great enough, it can
spread to the ureter and bladder leading to an abnormal urinalysis.
Most patients with appendicitis, however, have a normal urinalysis.
Therefore,
a normal urinalysis suggests appendicitis more
than a urinary tract problem.
Abdominal X-Ray
An abdominal x-ray may detect the fecalith (the hardened and calcified,
pea-sized piece of stool that blocks the appendiceal opening) that may be the
cause of appendicitis. This is especially true in children.
Ultrasound
An ultrasound is a painless procedure that uses sound
waves to identify organs within the body. Ultrasound can identify an enlarged
appendix or an abscess. Nevertheless, during appendicitis, the appendix can be
seen in only 50% of patients. Therefore, not seeing the appendix during an
ultrasound does not exclude appendicitis. Ultrasound also is helpful in women
because it can exclude the presence of conditions involving the ovaries,
fallopian tubes and uterus
that can mimic appendicitis.
Barium Enema
A barium enema is an x-ray test where liquid barium is inserted into the
colon from the anus to fill
the colon. This test can, at times, show an impression on the colon in the area
of the appendix where the inflammation from the adjacent inflammation impinges
on the colon. Barium enema also can exclude other intestinal problems that mimic
appendicitis, for example Crohn's disease.
Computerized tomography (CT) Scan
In patients
who are not pregnant, a CT Scan of the area of the appendix is
useful in diagnosing appendicitis and peri-appendiceal abscesses as well as in
excluding other diseases inside the abdomen and pelvis that can mimic
appendicitis.
Laparoscopy
Laparoscopy is a surgical procedure in which a small fiberoptic tube with a
camera is inserted into the abdomen through a small puncture made on the
abdominal wall. Laparoscopy allows a direct view of the appendix as well as
other abdominal and pelvic
organs. If appendicitis is found,
the inflamed appendix can be removed with the laparascope. The disadvantage of
laparoscopy compared to ultrasound and CT is that it requires
a general anesthetic.
There is no one test that will diagnose appendicitis
with certainty. Therefore, the approach to suspected appendicitis may include a
period of observation, tests as previously discussed, or surgery.
Next: Why can it be difficult to diagnose appendicitis? »
- CT Scan (Computerized Axial Tomography) - CT Scan (Computerized Axial Tomography, CAT scan) is a procedure that assists in diagnosing tumors, fractures, bony structures, and infections in the organs and tissues of the body.
- Abdominal Pain - Learn about abdominal pain (pain in the stomach / abdomen) including causes, symptoms, how abdominal pain is diagnosed, and how abdominal pain is treated.
- Ultrasound - Learn an ultrasound procedure, and conditions and diseases it assists in diagnosing and screening like tumors, cysts, heart conditions and more.
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