Appendicitis Diagnosis

Authored by Dr Mary Lowth, 01 Aug 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Adrian Bonsall, 01 Aug 2017

There is no foolproof test that can confirm appendicitis. Sometimes it is difficult for doctors to be sure that appendicitis is the cause of the symptoms.

A doctor may diagnose appendicitis quite easily if you have the typical symptoms. However, not everyone has typical symptoms. Sometimes it is difficult for doctors to be sure that appendicitis is the cause of the symptoms.

There is no easy, foolproof test that can confirm appendicitis. A surgeon often has to make the final judgement about whether to operate, based on their assessment of you. It therefore depends on whether your symptoms, and the findings when you are examined, suggest that appendicitis is the probable diagnosis.

Your tummy (abdomen) will be examined to assess where you are tender. This includes pushing into the tender areas to see if your muscles can relax, and where you are most tender. Blood tests may also help diagnosis. Urine testing is done to rule out urine infection, and women are usually offered pregnancy tests. Trials of a urine test looking for a protein called LRG are also continuing, which may help in diagnosis. Levels of LRG are very raised in the urine in appendicitis. However, this test is not yet widely available.

Imaging tests are often used to help decide on the diagnosis, if it is not clear. For example, an ultrasound scan or a CT scan may help to clarify the cause of the symptoms. If the diagnosis seems obvious or there is concern that your appendix has, or is about to, burst (perforate), you are likely to go straight to surgery. This will avoid the delay caused by taking you for a scan first.

Sometimes a surgeon advises to wait and see for a few hours or so while you are being monitored in hospital. This allows some time to see if your symptoms progress to a more definite diagnosis, or even if they change or go away. Antibiotic medicine will usually be given in this time.

Some people develop pain that is similar to appendicitis but which is caused by other conditions. For example:

  • Pelvic inflammatory disease.
  • Urinary tract infection (cystitis).
  • Passing a kidney stone (ureteric colic)
  • Inflammation of the large bowel (large intestine) - a condition called colitis.
  • Inflammation of the first part of the large bowel (the caecum) itself - sometimes seen in Crohn's disease.
  • In women the right ovary lies near to the appendix, so pain in this area could come from either organ. A leaking ovarian cyst, or the normal pain of ovulation (sometimes called Mittelschmerz) can mimic appendicitis.
  • Ectopic pregnancy (when a pregnancy starts to develop outside the womb, usually in one of the Fallopian tubes) can mimic appendicitis.
  • In children swollen glands in the tummy around the bowel (mesenteric adenitis), often associated with viral infections can mimic appendicitis.
  • Occasionally pain from gallstones or from inflammation of the gallbladder (cholecystitis) can mimic appendicitis.

Some people have surgery only to find that the appendix is normal and not inflamed.

Further reading and references

My question is, once diagnosed with Appendicolith, how long could it take before appendicitis develops? I have a 4 month history of kidney stones on and around both kidneys. I've had them blasted...

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