Appendicitis - Diagnosis

Many abdominal problems have symptoms like those of appendicitis. The task of the doctor is to rule out other problems before diagnosing appendicitis. The first step in diagnosis usually involves a series of questions about the patient's pain: where did the pain begin; has it moved, and where is the pain now? The doctor also presses on the abdomen to find out where the soreness is and how rigid the abdomen has become.

The sequence of symptoms described occurs in about half of all patients with appendicitis. In certain cases those symptoms may be harder to detect. For example, abdominal pain is common in pregnant women and can be the result of any number of factors relating to a pregnancy. Elderly people are likely to have less pain and tenderness than younger patients. The absence of these symptoms can make diagnosis more difficult. In about 30 percent of cases involving the elderly, the appendix ruptures before a diagnosis has been made. Infants and young children often have diarrhea, vomiting, and fever in addition to pain.

Laboratory tests cannot totally determine appendicitis, but do help in the diagnosis. A blood test that shows a high white blood count may be an indication of the infection. Urine tests can rule out other possible causes of abdominal pain, such as an infection of the urinary tract.

People who are diagnosed with appendicitis are usually taken directly to surgery. The doctor then performs a laparotomy (pronounced lap-uh-ROT-uh-mee), an operation on the abdomen. The laparotomy usually confirms a diagnosis of appendicitis.

In some cases, additional tests may still be necessary. For example, an ultrasound test may help identify appendicitis or other conditions that may have the same symptoms. A computed tomography (CT) scan may also be performed to avoid surgery. A CT scan is a procedure by which X rays are directed at a patient's body from various angles and the set of photographs thus obtained assembled by a computer program. This procedure is sometimes called a computerized axial tomography (CAT) scan.

Often, a diagnosis of appendicitis is not certain until an operation is done. To avoid a ruptured appendix, surgery may be recommended without delay if the symptoms point clearly to appendicitis.

Additional procedures may be used for women of child-bearing age. Women in this age group may have problems with their reproductive organs that produce symptoms similar to those of appendicitis. In these cases, a doctor may perform a laparoscopy (pronounced lap-uh-ROS-kuh-pee). In this procedure, a small incision (cut) is made near the navel. A tube containing a light and viewing device is then inserted through the incision. This allows a surgeon to look directly into the patient's abdomen. He or she can usually determine whether the patient has appendicitis or some other condition.

A normal appendix is found in about 10 to 20 percent of all patients who have a laparotomy. Sometimes the surgeon removes a normal appendix anyway to safeguard against appendicitis in the future. In about 30 percent of these cases, surgeons find other medical problems that have caused the appendicitis-like symptoms.