How to Tell if a Stomachache Is Actually Appendicitis

Screenings and Diagnostics

March 04, 2020

If you or a loved one have ever experienced a severe stomachache, chances are you’ve worried that it could be something far worse. The early symptoms of appendicitis are similar to those of stomach flu, food poisoning and some gastrointestinal or pelvic conditions, making it difficult to differentiate what’s actually causing your abdominal pain. Fortunately, there are several signs that indicate you’re suffering from appendicitis, as well as steps you can take if you’re unsure. 

What Is Appendicitis? 

The appendix is a small tubular-shaped piece of tissue located in the lower-right area of your abdomen. Although it may mildly aid the immune system when you’re a child, the body no longer relies on the appendix when you’re an adult. That’s why it can be surgically removed if it becomes inflamed.  

Appendicitis usually occurs when there’s a blockage. This causes the appendix to swell and become infected. Eventually, due to a lack of blood flow, the appendix can burst. Once the walls of the appendix are torn, then the site develops an even worse infection that can leak into the abdomen.  

What Does It Feel Like? 

There are several main indicators of appendicitis. Pain usually starts in the center of the abdomen, which may feel like a bad stomachache. Within a few hours, it migrates to the right, lower quadrant. According to the National Institute of Diabetes and Digestive and Kidney Diseases, other symptoms may include pain that:

• Significantly worsens in just a few hours

• Doesn’t decrease with over-the-counter pain reliever or anti-inflammatory medication

• Worsens when you move around, take deep breaths, cough or sneeze

• Is so severe it wakes you up when sleeping

• Appeared before other less specific symptoms

The less-specific symptoms of appendicitis may include:

• A loss of appetite

• Nausea

• Vomiting

• Diarrhea

• Constipation

• An inability to pass gas

• A low-grade fever

• Swelling of the abdomen

• The sensation that having a bowel movement would relieve discomfort

What if I Think My Pain Is Appendicitis?

Appendicitis is the most common reason for emergency abdominal surgeries in the U. S. If you’re experiencing some of the symptoms of appendicitis — especially if you have pain in the lower, right quadrant of your abdomen — then it’s time to seek immediate medical care. You’ll likely need to undergo a series of lab tests and a CAT scan of your abdomen and pelvic region, as well as face possible admission into the hospital for surgical evaluation. 

Can I Wait to See If It’s a Stomachache?

It’s possible that someone worried about a potential case of appendicitis may be suffering from something less serious. Still, it’s better to be safe than sorry. If appendicitis goes unchecked, it can result in perforation of the appendix, bacterial spillage and gangrene of the gut. Over time, this can cause septic shock. In rare cases, a ruptured appendix can even lead to death. The treatment and recovery time for a ruptured appendix is also far longer and more complicated. 

Remember to trust your gut. An earlier evaluation will lead to an earlier diagnosis. You’ll also be able to undergo a laparoscopic appendectomy, which is associated with a reduced risk of surgical site infection, a reduced risk of subsequent bowel obstruction and a faster return to normal life.

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Not Just a Stomach Ache: Symptoms of Appendicitis

CS-Blog

Cedars-Sinai Blog

Jul 06, 2017
Cedars-Sinai Staff

Most of the time, an achy stomach isn’t anything serious. But when your pain persists, migrates, or is accompanied by other serious symptoms, a trip to the emergency room could be in order.

For more than 600,000 people each year, stomach pain is their first clue that their appendix has torn and they’re suffering appendicitis.

How do you sort out when it’s a stomach ache and when it’s appendicitis? Dr. Rodrigo F. Alban, associate director of the General Surgery Residency Program at Cedars-Sinai, offers this explanation of appendicitis and the symptoms to watch out for.

The appendix is part of the large intestine—a small, finger-shaped organ about 4 inches long, whose function is still largely a mystery, though it might offer a breeding ground for healthy gut bacteria after an infection. Or it may do nothing at all. Experts are still undecided. But when it tears, it has to be removed.

Appendicitis causes

Rodrigo F. Alban, MD

Sometimes stool can get stuck in the appendix, which is shaped like a tube with one closed end. Like a balloon that’s been tied off, there’s no way for what’s trapped inside to escape. The pressure builds as the appendix continues producing its normal secretions. The organ swells, and once this process starts, the appendix can tear or rupture.

In children, appendicitis can start when the certain tissues in the appendix that are rich in immune system cells get swollen. When kids get appendicitis, it’s usually this and not a fecal obstruction that causes it.

When to seek help

Your stomach pain is worth a trip to the emergency room when:

• Pain is severe and doesn’t let up
• Your stomach is tender to the touch
• The pain extends to you back
• Pain is accompanied by:
  • Fever
  • Vomiting
  • Difficulty breathing
  • Chest pain
  • Irregular heartbeat
  • Light-headedness
  • Dark or black stool
  • Vomiting blood

Read: Unraveling How Gut Bacteria Affect Our Health

Symptoms commonly associated with appendicitis

Migrating pain: Your appendix troubles might start several days before the organ becomes torn or ruptures. During this time, you might have pain in the middle of your abdomen that feels like an upset stomach. If your appendix is the issue, this pain tends to move to the right or lower right side of the abdomen.

Nausea and vomiting: Nausea and vomiting are associated with appendicitis, but diarrhea is more consistent with a gastrointestinal infection.

Loss of appetite: Dr. Alban will ask a patient, “What is your favorite food?” And then, “Would you want to have something like that right now?” If a patient says they’re not interested in their favorite dish, it tips him off to pain so bad that it has caused loss of appetite.

Fever: A small tear might cause pain contained to the lower right side of the body. If untreated, the infection can spread through the abdomen causing fever and other symptoms.

Making a diagnosis

Doctors will often administer a blood test to check for a high white blood cell count, which would clue them in to an infection. You might also have an imaging test, like a CT scan.

Ruling out other conditions is also part of the process. Women can sometimes be more difficult to diagnose, because appendicitis has similar symptoms to ovarian cysts and other gynecologic conditions. Doctors will also try to rule out gastroenteritis and bowel diseases, as well as kidney stones in older people.

Read: Heartburn and Acid Reflux: What You Need to Know

How it’s treated

Once you’ve been diagnosed with appendicitis, there are several options.

If the appendix is swollen and infected, but has not torn, it’s usually removed with a minimally invasive procedure requiring a few small incisions. These patients often go home on the same day.

If the appendix is already torn or ruptured, the surgery is more complex. Any abscess has to be drained and then the patient is treated with antibiotics. Once the swelling goes down, the appendix is removed.

More severe cases might require an open surgery, with a larger incision.

Question to the doctor: how not to miss an attack of appendicitis

It would seem that everyone knows everything about appendicitis (or, in any case, they are sure that they do). However, this well-understood disease can be tricky in terms of diagnosis, and many patients have no idea “how exactly it hurts with appendicitis.” How to understand that you need to see a doctor urgently? How not to miss an attack?

About this – Head of the Department of Abdominal Surgery of the National Medical Research Center of Surgery. A.V. Vishnevsky, Doctor of Medical Sciences, Professor Andrey Germanovich Krieger.

What increases the risk of appendicitis?

Nobody knows. Medicine is an imprecise science.

Lifestyle, stress, nutrition?..

Neither physical activity, nor psychological troubles, nor a person’s dietary preferences affect. In men and women, the incidence of the disease is almost the same (another thing is that women are more likely to suspect appendicitis, but then gynecological problems are detected).

That is, the disease has long been described and it has long been clear what to do with it, but the risk factors are still unknown?

Unknown.

Does it make sense to remove the appendix prophylactically?

No way. Any surgical intervention carries the risk of complications, and appendectomy – removal of the appendix – is far from an indifferent operation. And not as simple as it might seem. After it, always, naturally, inevitably, adhesive adhesions occur, which can lead to intestinal obstruction, the occurrence of adhesions.

In America in the 1950s and 1960s there was a wave of prophylactic appendectomy for newborns. Refused, fortunately. The practice didn’t pay off.

Does the appendix also perform certain immunological functions?

Yes, and it is also called the intestinal tonsil, because here is the lymphoid tissue, which has a certain significance in the general immunological status of a person.

What are the symptoms of acute appendicitis?

Pain in the right iliac region (on the right lower abdomen) – not intense, constant, aching, dull, not giving anywhere. It hurts and – aching, aching, aching … And it gets worse with movement.

And many people think that appendicitis is when “it hurts in the side, it hurts”…

That’s when it hurts – it’s not appendicitis. If a person feels unbearable pain in the abdomen, it is most often colic (renal, biliary) or perforation of a hollow organ (perforated ulcer). Then there are the so-called dagger pains.

It turns out that the widespread opinion that appendicitis is a sharp pain that a person cannot endure is wrong?

Completely wrong. This pain can be tolerated, so quite often people do not go to the doctor in a timely manner.

What does constant pain mean? A day, two, three, a week?

One, two, three.

Or maybe appendicitis pain behave like this: it hurt for an hour or two and passed, the next day it hurt again for an hour or two and passed?

No, it can’t. If it started, then it aches, aches and intensifies with movement.

So call an ambulance?

Of course.

But not everyone will call an ambulance if they experience pain that can be endured for a couple of hours.

That’s the problem. I already said – quite often people do not do it on time. But we must understand that acute appendicitis is a risk of peritonitis, a life-threatening condition.

How does it all start with appendicitis?

Pain occurs in the epigastrium (upper abdomen) or throughout the abdomen. Then nausea appears (vomiting may not be there or it is one or two times). After 3-5 hours, the pain moves to the right iliac region (lower abdomen on the right). And if everything develops in this way, we can talk about inflammation of the appendix (in medicine this is called pathognomonicity – a symptom characteristic of a particular disease). The usual story of the patient goes something like this: “It hurt, something twisted in the stomach, I couldn’t understand what was the matter 2-3 hours ago, but now I got up, walked and felt that now it hurts in the right lower abdomen. ” Oh my dear, it’s appendicitis!

Do characteristic symptoms make diagnosis easier?

In the vast majority of cases – yes, the diagnosis of acute appendicitis is made quite simply and confidently: epigastric pain after 2 hours shifted to the right iliac region, leukocytes are elevated, temperature is 37.2 (the so-called Kocher’s onset, Kocher’s symptom).

Why are diagnostic errors allowed in this case?

First, the clinical picture can be the same in a number of diseases. Secondly, we talked about the classic symptomatology, which, fortunately, happens in most people, when the appendix is ​​located exactly where it is most often located. But there may be anatomical variations.

What, for example?

For example, in a woman, the caecum is elongated and shifted into the small pelvis: the fallopian tube lies, and next to it, right on top of it, is the appendix. And he got inflamed. So try it, conduct a differential diagnosis between salpingitis (inflammation of the fallopian tube) and appendicitis, when it is necessary to inflame one organ, immediately the contact inflammation passes to another.

Why did women in the past, when there was no laparoscopy, often undergo unnecessary appendectomies? Pain in the right lower abdomen. Hurts? Hurts. They take it to the table. They enter the abdomen, there is no appendicitis, but there is, for example, an ectopic pregnancy. But the shoot was removed in any case.

Why, if no appendicitis was found?

When there was no laparoscopy, surgical access for suspected appendicitis was made on the right lower abdomen. For any surgeon, such a characteristic scar was evidence that the patient had already had an appendectomy. And, if the next time a person was admitted to the hospital with complaints of abdominal pain, appendicitis was immediately ruled out and looked elsewhere. Otherwise (there is a scar, but the appendix is ​​not removed), confusion could arise with serious consequences.

But does the person remember that they “removed his appendix”?

Not always.

With all the knowledge of the disease, the diagnosis is not so simple. ..

Of course, it is not easy. Another option: if the appendix is ​​high, next to the gallbladder, then there will be a clinic, as in acute cholecystitis. Only acute cholecystitis does not need to be urgently operated on, because the gallbladder does not perforate a day after the onset of the disease, but acute appendicitis is necessary. But, unfortunately, there are situations when acute cholecystitis is diagnosed, dynamic observation is carried out, but it turns out to be purulent appendicitis, as a result – perforation, peritonitis …

How often does this happen?

It happens. It is no coincidence that mortality in appendicitis does not decrease. It is small (0.03 percent), but is not decreasing.

This is despite the fact that instrumental research methods today are not the same as 20-30 years ago?

Yes, and the main reason is late diagnosis. A late diagnosis is either a person did not go to the doctor in time, or a diagnostic error was made.

Has the operation itself changed?

Technically, the operation to remove the appendix has not undergone any changes – this is a classic example of the so-called amputation surgery. Only now it is carried out in a more gentle way – laparoscopically.

What are the symptoms of appendicitis?

The most common symptom of appendicitis, inflammation of the appendix of the caecum, is pain in the lower right abdomen. Initially, the pain can be of varying intensity (strong, weak) and nature (constant, intermittent), and after 6-7 hours it intensifies and is mainly felt in the lower right part of the abdomen, the projection site of the appendix. Appendicitis pain is usually aggravated by movement and tension of the abdominal muscles, such as coughing, as well as by lying on your back with your legs straight, as pressure on the peritoneum increases.

What other symptoms are there?

The symptoms of appendicitis may be the same as those of poisoning. Due to the fact that pain in the peritoneum is not always clearly localized, the diagnosis can be erroneous in the early stages of the disease.

“A symptom of appendicitis is primarily local pain. There may also be a temperature, but everything is determined upon examination. It is difficult to name a specific set of symptoms, since it is necessary to conduct a number of studies of functional diagnostics, to compare symptoms with signs of other acute diseases. Women also need to undergo gynecological examinations, since appendicitis can easily be confused with inflammation of the appendages, ”says the surgeon, head of the surgical department of the city clinical hospital named after. V. V. Vinogradova (City Clinical Hospital No. 64) Vladimir Kulabukhov.

In addition to acute abdominal pain, other symptoms may indicate appendicitis.

Loss of appetite and nausea

Appendicitis is characterized by loss of appetite. This symptom may either precede or accompany the nausea. If these symptoms do not disappear for a long time, you need to see a doctor for an accurate diagnosis.

Vomiting

A symptom of appendicitis may be vomiting with an admixture of bile. Vomiting may indicate the development of peritonitis, but it can often occur with simple appendicitis. According to Johns Hopkins Children’s Center pediatrician David Bundy, signs such as loss of appetite, nausea and vomiting are not exclusive symptoms for making an accurate diagnosis in children and adults. According to him, about 80% of cases of appendicitis in children under 4 years of age end in a rupture. This is partly because young children rarely have the classic symptoms (nausea, vomiting, and pain localized to the lower right abdomen) than do teenagers and young adults.

Increased body temperature

During appendicitis, body temperature does not rise above 37 degrees. But if you did not determine the cause of the pain in time and you have a complication, then the body temperature can reach 40 degrees.