Acute appendicitis

Alternative names:

appendicitis

Symptoms:

• abdominal pain
  • pain may begin in the upper-middle abdomen (epigastric), then develop to sharp localized pain
  • pain may shift from the epigastric area to become most intense in the lower right side of the abdomen ("typical" presentation), tenderness of this area is common
  • pain initially may be vague, but getting increasingly more severe

• point tenderness
• abdominal pain may be worse when walking or coughing
• nausea and vomiting
• fever usually occurs within several hours
• the patient may prefer to lie with knees pulled up to abdomen to relieve muscletension on the abdomen

Later symptoms:

• fever
• loss of appetite
• nausea
• vomiting
• constipation
• rectal tenderness
• chills and shaking

Additional symptoms that may be associated with this disease:

• urine, bloody (microscopic hematuria)
• anal lump
• menstruation, painful

Signs and tests:

When the abdomen is gently pressed in the painful area, and then the pressure is suddenly released, the pain increases (rebound tenderness). Touching the abdomen may cause spasm of the abdominal muscles if peritonitis is developing. Rectal examination causes pain that is localized on the right side. Psoas sign is positive--the person is placed on his (her) back in a supine position and the legs are extended straight. Tapping the heels or jarring the leg upwards causes increased pain on the right side of the abdomen.

Appendicitis may be strongly suspected based on the following tests:

• An abdominal sonography may show appendicitis.
• A CBC shows increased white blood cell count.
• An abdominal X-ray may or may not show signs of appendicitis.

The diagnosis may be confirmed by the surgeon during an exploratory laparotomy.

This disease may also alter the results of the following tests:

• barium enema
• abdominal tap (paracentesis)
• abdominal CT scan