By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

APPENDICITIS CAN BE TRICKY DIAGNOSIS, EVEN FOR SKILLED PHYSICIAN

Question: Recently my son had his appendix removed. He was mildly ill for several days before I took him to the doctor. I felt very bad for not taking him sooner. What are the symptoms of appendicitis? Should I have known that’s what this was? He didn’t have much pain or fever.

Answer: Appendicitis is a relatively common abdominal problem that requires surgery. It can be very difficult to diagnose, however, as you now know. About one person out of every 1,000 suffers from appendicitis each year. The incidence peaks in the teenage years, and males are affected slightly more than females. Appendicitis is less common in countries and cultures with high dietary fiber intake.

The appendix is a small, hollow structure that has been described as having a finger-like appearance. It is located in the lower right abdomen where the small and large intestines connect.

Appendicitis generally follows obstruction of the appendix by feces (fecalith), a foreign body, or rarely, a tumor. Typically, the first symptom is a cramping or "colicky" pain around the belly button. There is usually a marked reduction in, or total absence of, appetite. In more than 80 percent of cases, the pain migrates from a central location to the lower right side of the abdomen. This area may become tender and develop what doctor’s call “point tenderness.” Nausea, vomiting and low-grade fever may also be present. However, nausea is more common than vomiting, and the low-grade fever is often absent in the elderly.

Since the appendix is a finger-like structure that “hangs off” the intestines, it can move around a bit. Sometimes it curls up toward the upper right part of the abdomen. If it becomes inflamed when this position, it can cause pain in the back or upper abdomen. The appendix also can be long and lay across the floor of the abdomen. In this configuration, it can mimic bladder or female problems, and even produce pain on the left side of the abdomen.

Commonly, a person with appendicitis will tell you that his or her pain is worse when he or she coughs or goes over a bump in the road on the way to the hospital. Also, if you tap on the abdomen of someone with appendicitis, they will usually tell you it causes pain.

So you can see, the diagnosis of this condition can be difficult even for a skilled and experienced physician. If the symptoms indicate the possibility of appendicitis, your doctor will ask for a blood test to check for an elevated white blood count that can indicate infection. A urine specimen, C-T scan of the abdomen, and ultrasound can also be useful. Very old people and the very young can have very unique presentations of appendicitis.

Timely diagnosis can prevent complications like rupture of the appendix, which before the days of antibiotics meant almost certain death. Fortunately, today’s modern laparoscopic surgical techniques mean that removing the appendix is a fairly uncomplicated procedure in most cases, with a rapid recovery the norm.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.