Do I have appendicitis?

Chances are you have awoken in the middle of the night, felt a pain in your abdomen, maybe in the right lower side, and have wondered to yourself whether you might have appendicitis.

First let me say that there is nothing that replaces an examination by a physician, particularly an experienced surgeon. If you are concerned that you have appendicitis, then you should see a physician as soon as possible, either in an emergency room or your family doctor. I would offer the warning here that nothing you read here replaces an examination or blood testing.

McBurney point

That said, there are warning signs that your abdominal pain might be appendicitis:

1. Abdominal pain which begins as a vague cramping pain around the navel and which then migrates to a specific pain in the right lower quadrant of the abdomen, particularly at a point half way between the navel and the spine of the pelvic bone, called McBurney's point.

2. The cramping pain will frequently be associated with nausea and/or vomiting.

3. The cramping or colic of the obstructed appendix will also frequently create some cramping in the colon, and will lead to a feeling of tenesmus, or as I ask my patients, "do you feel as if you could just move your bowels then everything would be alright?"

4. Patients will frequently develop a low grade temperature or sweats with the abdominal pain.

5. If the appendix ruptures, the pressure in the cramping, full appendix will suddenly be relieved. Patients will often suddenly report feeling abruptly better, their cramping pain will go away. A fever will follow in 10-60 minutes, and as a localized peritonitis develops in the area around the appendix. This will lead to intense pain in the area of the appendix.

6. As the inflammation/peritonitis increases, it will hurt to move that area of the abdomen. This will lead to "rebound pain" - that is pain when pressure is suddenly released in the abdomen, creating motion of the contents of the abdomen. Similarly, bumps in the road on the way into the hospital will cause pain.

Psoas Sign - YouTube


7. There are two physical diagnostic signs of peritoneal inflammation of the appendix - "Rovsing's sign" the "Psoas sign" and the "obturator signs" with specific motions causing pain (see diagrams)

8. One compelling reason to go to the Emergency Room is to have the blood examined for an elevation in the counts of White Blood Cells (WBC). An elevation of the WBC is a non-specific indicator of a problem, but when combined with the appropriate symptoms, such as pain at the appropriate point, a good story, fever, nausea etc…, it is frequently helpful in making a diagnosis.

9. The main reason to go to the Emergency Room is to be examined by someone experienced in the diagnosis of appendicitis.

The Alvarado Score

There is a statistically validated scored test to determine the likelihood of a patient having acute appendicitis. It is a ten point scale based on both symptoms and the results of the White Blood Cell Count. It is used in Emergency departments to try to limit the routine use of CT scans in diagnosing appendicitis, the higher the score, the more certain the diagnosis.

Take the test, see how you do. Remember,without a blood test you cannot determine three of the ten points. If you have a score of 4 or greater, you should probably think about going to the hospital to be seen.