Appendicitis

I saw a patient a few weeks back who was brought in by her dad presenting with a typical medical dilemma…is the patient’s abdominal pain appendicitis or not?  Unfortunately, there is usually not an obvious answer; the diagnosis is usually made by reviewing a combination of symptoms, compiling telltale findings on examination, and verification with the use of an imaging study.

Appendicitis usually causes a constant pain in the lower abdomen (below the navel), often starting as a generalized discomfort and typically localizing to the lower right side.  Patients usually have a fever, nausea and loss of appetite.  Examination classically demonstrates “rebound”, which is increased pain with movement such as walking or coughing.  Intestinal sounds are often decreased or absent when evaluated with a stethoscope, and the abdominal muscles reflexively tighten to “guard” the stomach when compressed.  The white blood cell count, which measures infection, is usually elevated.  Most often, only a few of the above symptoms and signs are present, especially early in the infection, making the diagnosis more difficult.  Other conditions such as intestinal flu, kidney stone, gynecologic infection and inflammatory bowel disease, among others, can mimic appendicitis.  When the diagnosis is in doubt, the physician will usually order a CT scan or ultrasound.  If appendicitis is confirmed, surgery is required to remove the infected organ.  If caught early, recovery is usually prompt.  For this reason, always seek immediate medical care whenever there is acute, unexplained abdominal pain.

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