Appendicitis – Diagnosis and Treatment
Diagnosis
Doctors figure out if someone has appendicitis by asking questions, doing physical exams, running lab tests, and ordering imaging scans.
They usually start by asking about symptoms like pain in the lower right belly, fever, nausea, vomiting, and appetite changes.
A lot of people mention pain that begins near the belly button and then shifts to the lower right side. Low fever and nausea pop up pretty often, too. During the exam, a doctor gently presses on the belly to check for soreness.
They might quickly release pressure to see if the pain gets worse — a sign that the lining of the belly may be irritated (called rebound tenderness). Sometimes, doctors also check for special signs like the:
- Psoas Sign: Right lower belly pain when lifting the right leg or extending it.
- Obturator Sign: Pain when the right hip is bent and rotated inward.
- Rovsing Sign: Pressing on the left side causes pain on the right.
If the muscles tighten up when pressing over the appendix, that can be a clue as well.
Other tests doctors use include:
| Test Name | What It Checks For |
|---|---|
| Blood test | High white blood cell count (leukocytosis) or signs of inflammation |
| Urine test (urinalysis) | Signs of a urinary tract infection or kidney stones |
| Ultrasound | Inflammation of the appendix or blockage in the appendiceal lumen |
| CT Scan | Swelling, inflammation, or a fecalith blocking the appendix |
| MRI | Used in some cases, especially during pregnancy, to see the appendix more clearly |
Doctors sometimes do a digital rectal exam or a pelvic exam, depending on the situation. Imaging tests like ultrasound or CT scans help confirm if the appendix is inflamed, blocked, or even ruptured.
Doctors use all this information to decide if a patient needs immediate treatment for acute appendicitis.
Treatment
Removing the Appendix by Surgery
Surgeons usually treat an infected appendix by removing it. This operation, called an appendectomy, gets rid of the appendix before things get worse.
There are two main ways surgeons do this:
- Open Surgery (Laparotomy): The surgeon makes a single cut, about 2 to 4 inches long, on the lower right side of the belly.
- Minimally Invasive Surgery (Laparoscopic): The surgeon makes a few small cuts and uses a camera and special tools to remove the appendix.
Laparoscopic surgery usually means less pain, smaller scars, and a faster recovery. Older adults and people carrying extra weight often do better with this method.
Open surgery can be safer if the appendix has burst, infection has spread, or there’s an abscess. This way, surgeons can clean the inside of the belly more thoroughly.
Most patients stay in the hospital for a day or two after surgery. Doctors give antibiotics before and after the operation to help prevent or treat infections. If the appendix hasn’t burst, people usually recover quickly and with fewer problems.
Treating a Pocket of Infection before Removing the Appendix
A burst appendix can cause an abscess, which is basically a pocket of pus. Doctors usually drain the abscess first by putting a thin tube through the skin.
This helps stop the infection from spreading and lowers the risk of serious problems like sepsis. Once the infection is under control, surgeons plan to remove the appendix a few weeks later.
For milder cases, doctors might use a broad-spectrum beta-lactam/beta-lactamase inhibitor combination antibiotic to fight the infection.
This type of medication is usually given through an IV in a hospital setting and may be part of a non-surgical treatment plan for appendicitis, especially when surgery isn’t immediately necessary.
If the appendix isn’t removed, there’s a bigger chance the problem will come back, so surgery is still recommended when it’s safe.
Everyday Care and At-Home Tips
After an appendectomy, people need to pay attention to daily habits and tweak routines at home to heal well.
Doctors usually tell patients to avoid heavy lifting or tough exercise for several days, depending on the surgery type. Patients who had laparoscopic surgery usually bounce back faster than those who had open surgery.
Using a pillow to support the belly while coughing, laughing, or getting up can ease discomfort. If pain medicine isn’t helping, it’s smart to call a healthcare provider.
Getting enough sleep and resting when tired gives the body a chance to recover. Short, gentle walks are actually a good idea. They help keep digestion on track and lower the risk of blood clots.
It’s important to listen to your body and slowly get more active. Eating well also matters for healing. Drinking plenty of fluids helps prevent constipation, which is common after surgery.
Foods that are easy to digest—like soups, fruits, and whole grains—can be gentler on your system. Some people find that warm or cold packs help with mild pain near the incision.
Always check with a healthcare provider before jumping back into work, school, or sports. Kids often need extra time before they can be active again.
Alternative Approaches
Some people try extra methods along with medicine to manage pain after appendix surgery. Listening to music, chatting with friends, or even simple meditation can help the body relax.
A lot of patients, especially kids, find that distractions make things easier. Rest is still a big part of getting better. These things can help with comfort and healing, but they don’t treat the root cause like infection or worms.
Getting Ready for Your Visit
Before your appointment, check with the facility to see if you need to stop eating or drinking before certain tests. Write down all your symptoms—not just stomach pain, but also things like appetite loss, constipation, diarrhea, or nausea.
If you’ve felt extra stressed or had mood changes, jot that down, too. Family health history actually matters, since problems with the appendix can run in families. Make a list of your medications, vitamins, or supplements, plus the doses.
Bringing a trusted friend or family member can help you remember what the doctor says.
Some good questions to ask include:
- What could be causing these symptoms?
- Do I need more tests?
- Is appendicitis the most likely reason?
- Will I need surgery? How soon?
- What complications could happen, especially if the appendix has burst?
- How long will recovery take?
- When can I get back to normal activities?
A simple table can help you keep track:
| Questions to Ask | Details to Write Down |
|---|---|
| Is surgery required? | List all symptoms (pain, nausea, etc.) |
| Recovery timeline | Recent stresses or life changes |
| Risks of surgery | Family history of digestive issues |
Questions the Healthcare Professional May Ask
Your healthcare provider usually starts by asking when your abdominal pain began. They’ll want to know where it hurts, how bad it feels, and if the pain has moved around at all.
They might ask if you’ve lost your appetite, or if you’ve noticed constipation or diarrhea. Sometimes, they’ll check if you’ve had symptoms like fever or even anorexia.
You’ll probably get a few questions about what makes the pain better or worse. Nausea? They’ll ask about that too.
Honestly, it’s pretty normal for them to run through a checklist—especially with teenagers, since they’re often affected. The provider will likely ask about your personal and family medical history, plus any medications you’re taking.
If you have those answers ready, the whole visit tends to go a lot smoother.
