SIGNS AND SYMPTOMS OF APPENDICITIS


Symptoms of appendicitis usually include pain in the lower right abdomen, loss of appetite, nausea and or vomiting, with or without fever. There may be mild diarrhea or constipation. The site of this pain could be higher in appendicitis in pregnancy, or even lower in those with very long appendix. Other variations are not uncommon, as we shall discuss below.

Even though appendicitis is a very common condition, it could often be difficult to diagnose with certainty because it is a mimicker of a host of other diseases and conditions. Please see a list of other conditions that can look like appendicitis, referred to as differential diagnosis of acute appendicitis.

Because of this difficulty in the diagnosis of appendicitis, a 15 % error margin is allowed in the diagnosis of appendicitis. This means that in almost 1 in 5 cases, your doctor may miss the diagnosis.

Children less than 3years, and adults older than 60 years have a very high chance of perforation due to delayed diagnosis, as appendicitis is often not considered to be a problem in these age groups. This should not be.

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Early Symptoms of Appendicitis

Early symptoms of appendicitis are those symptoms that most people with this condition may recognize and complain of.

They include lower right sided abdominal pain of gradual onset, feeling sick (or nausea), and loss of appetite.

Any one with these three symptoms can be assumed to have appendicitis until proven otherwise. We discuss these in more details:


  • Abdominal pain. This pain typically starts from around the belly button (peri-umbilical region), or the upper central abdomen (epigastrium) and then move downwards and to the lower right abdomen (right iliac fossa). When the pain occurs in this pattern, it is the most dependable of all symptoms of appendicitis, as over 8 out 10 (80%) cases that present this way is definitely due to the appendix.

    In some other individuals, the pain starts right way from the right iliac fossa. Depending on where the tip of the appendix is, the pain could even be on the right flank (retro-caecal appendix).

    If the appendix is quite long, and in the pelvic cavity, it could as well cause lower left abdominal pain, with frequent passage of urine if the inflamed appendix irritates the bladder.

    Pain in the scrotum has been reported due to a retro-ileal appendix.

    In pregnancy, the pain could be anywhere in the abdomen, due to the uterus displacing the appendix from its normal location.

    The pain may be continuous, worsened by movement and reduces on lie still in bed.

    When the appendix is severely inflamed, the pain can be localized to a spot on the outer one third of a line drawn between the belly button and front of the tip of the waist bone called the McBurney’s point.

    The Mc Burney’s point is also often the point of maximum tenderness when the abdomen is examined.

    The pain is even worse when the hand is suddenly removed from that spot because of the appendix rubbing on the covering of the abdomen (Rebound tenderness).

    There is also a sign referred to as the Rovsign sign. This is said to exist when the lower left abdomen is palpated by the doctor, but causes pain in the right.

    If the appendix is the pelvic type, examining the back passage (rectal examination) would cause some pain too.

    If the hip is moved and stretched, this can also cause pain to be felt at the spot where the appendix lies. This is referred to as the psoas sign.


  • Loss of Appetite, Nausea & Vomiting. This is another very important set of symptoms of appendicitis. It is said that loss of appetite is the most constant symptom of appendicitis (the diagnosis is in doubt if you still feel hungry and maintain a good appetite!)

    In about 9 of 10 (90%) individuals with appendicitis would have a feeling of wanting to be sick or vomit (nausea)... another very important symptoms of appendicitis.

    They may actually vomit. It is important to note that vomiting in appendicitis usually follows the pain. If you vomit before the pain commenced, it is not likely that the appendix is to blame.


  • Change in Bowel Habit. There may be diarrhea or constipation, especially in young children. This could lead to a wrong diagnosis of food poisoning or gastroenteritis on the part of the unwary doctor. Up to 1 in 5 persons (20%) could have diarrhea or even constipation with appendicitis.


  • Fever . There is usually a low grade fever in most patients with this disease. Nevertheless, in up to 1 in 5 persons (20%), they have normal temperature, even with severe disease. Temperature above 38.5 degree centigrade with rigors is suggestive of a ruptured appendicitis.


  • Other signs and symptoms of appendicitis may include pain in the scrotum in kids or new born baby if the appendix moved into the scrotum and became inflamed there or a retro ileal (behind the small intestine) appendicitis.

In adults, the appendix can rest on the bladder wall on rare occasions and cause irritation of the bladder. This may present as a patient with the signs and symptoms of appendicitis, as well as passing urine frequently. There may be blood in the urine of such ones.


Early Signs of Appendicitis


For the doctor, the following additional signs may be elicited during examination of someone suspected to have appendicitis :


  • Guarding. This is said to occur when the abdominal wall becomes rigid during examination. It occurs when ever there is peritonitis, localized as in appendicitis, or even in generalized peritonitis.

    There are two forms of guarding – Voluntary and Involuntary. Voluntary guarding is said to occur when a patient visibly contracts the muscles of the wall of the abdomen during examination to prevent the examiner pressing deep into the abdomen. The muscle can be seen to relax once the examiner removes his or hands.

    Involuntary guarding is a reflex spasm of the muscles of the abdominal wall, and is not within the control of the patient. The abdomen remains rigid even after examination, and this may be seen as an abdomen that does not move with respiration. Abdominal rigidity or involuntarily guarding is a very bad sign and may indicate a perforated appendicitis.


  • Obturator Sign is said to be positive when passive flexion (bending) of the right hip with internal rotation triggers pain in the right lower abdomen. It is a sign of irritation of the obturator muscle by the inflamed appendix.


Do you have a lower right sided abdominal pain, and you are not sure if it is due appendicitis? You can find out now by contacting a doctor. If you live in the US, register with, and get a Board Certified Surgeon via The PhoneConsultation Service. If you are in the UK, get a paid consultation now.



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