Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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 or her 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 in the process. 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 to confirm a diagnosis 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 provide images of 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
in which 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 laparoscope. 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.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
Medical shock is a life-threatening medical condition. There are several types of medical shock, septic shock, anaphylactic shock, cardiogenic shock, hypovolemic shock, and neurogenic shock. Causes of shock include heart attack, heart failure, heavy bleeding (internal and external), infection, anaphylaxis, spinal cord injury, severe burns, chronic vomiting or diarrhea. Low blood pressure is the key sign of sock. Treatment is dependant upon the type of shock.
Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Digestion RSS
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