Appendicitis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Patients with appendicitis commonly present with pain near the navel that eventually localizes to the right iliac fossa, loss of appetite, fever, nausea, and vomiting.

History

Asking specific questions about symptoms and health history will help rule out other conditions. The onset, location, severity of pain and knowing when other symptoms appeared relative to the pain is helpful. Questions about other medical conditions, previous illnesses and surgeries, and use of medications, alcohol, or illegal drugs are also included.

Symptoms

Common Symptoms

Symptoms of acute appendicitis can be classified into two types: typical and atypical (Hobler, K., 1998).

Typical Symptoms

Typical symptoms may include:

• Abdominal pain which:
  • Starts centrally (in the periumbilical region) before localizing to the right iliac fossa (the lower right side of the abdomen). This is due to the poor localizing (spatial) property of visceral nerves from the mid-gut, followed by the involvement of somatic nerves (parietal peritoneum) as the inflammation progresses.
  • Occurs suddenly, often causing a person to wake up at night
  • Occurs before other symptoms
  • Begins near the belly button and then moves lower and to the right
  • Is new and unlike any pain felt before
  • Gets worse in a matter of hours
  • Gets worse when moving around, taking deep breaths, coughing, or sneezing
• Loss of appetite
• Fever may occur
• Nausea may occur
• Vomiting may occur
• Constipation or diarrhea
• Inability to pass gas
• The feeling that passing stool will relieve discomfort

With the typical presentation of appendicitis the diagnosis of the disease is easier to make, surgery occurs earlier and findings are often less severe (Hobler, K., 1998).

Less Common Symptoms

Appendicitis presenting with atypical symptoms is more difficult to diagnose than with typical symptoms. CT scans and ultrasound is more useful in the diagnosis of the disease when these atypical symptoms present. Surgical findings (suppuration, abscess, perforation, etc.) are more apt to be severe in cases presenting with these symptoms (Hobler,K., 1998).

Atypical Symptoms

Atypical symptoms may include:

• Pain beginning and staying in the right iliac fossa
• Diarrhea
• A more prolonged, smoldering course.
• Increased frequency of urination
• This occurs when the inflamed appendix lies in contact with the bladder.
• With a post-ileal appendix, marked retching may occur
• During the third trimester of pregnancy where the location of the appendix migrates a few centimeters cephalad with the enlarging uterus, the pain may localize to the mid or even the upper right side of the abdomen.