How to tell if your abdominal pain is appendicitis

When it comes to abdominal pain, appendicitis usually isn’t the first thing that comes to mind. Many would automatically assume the discomfort for a bout of food poisoning, since the symptoms of both conditions are pretty similar. But unlike food poisoning, appendicitis usually rapidly worsens in a matter of hours and is considered a medical emergency. 

As a general surgeon in Singapore, I’ve seen cases where patients ignore the pain or try a wait-and-see approach only to be faced with a life threatening situation. Don’t let that be you — here’s how to tell if a stomach ache is actually appendicitis and what to do should you be diagnosed with the condition. 

What is appendicitis, and why does it happen? 

The appendix is a small, thin tube that’s joined to the large intestine and sits at the lower right area of the abdomen. In younger children, the appendix works with the immune system to fight disease. But as we get older, our appendix stops doing this and other parts of the body take over to help fight infection. In a sense, the appendix is not exactly a vital organ, which is why it can be safely removed without compromising our gastrointestinal tract. 

Appendicitis usually occurs when there’s a blockage in the appendix, which causes it to swell and become infected. Due to a lack of blood flow, if not treated in time, the appendix can burst, allowing stool, mucus and infected material to leak into the whole abdomen. This can lead to peritonitis, a life threading condition. 

In many cases, the cause of appendicitis is unknown and can be totally random. It may be due to infections in the digestive tract, or if the tube that joins your large intestine and appendix is trapped by stool. In rare cases, appendicitis can even be caused by tumours or intestinal worms. 

Does this mean there are no risk factors for appendicitis and anyone can get it? 

The short answer is yes, anyone can get appendicitis and there is no known specific food, drink, activity or condition that predisposes an individual to appendicitis. With that being said, most cases of appendicitis happens to people aged 10-30 years old. If you have a family history of appendicitis, then your risk increases as well. From what I’ve seen, children with cystic fibrosis also have a higher risk of getting appendicitis.

How do I differentiate appendicitis from regular stomach pain? 

There are a few main indicators of appendicitis. Pain is the most common symptom, which: 

  • Starts in the middle of the tummy and travels to the lower right abdomen
  • Gets progressively worse in a few hours
  • Worsens when you cough, sneeze, move around or take deep breaths 
  • Does not get better with pain or anti-inflammatory medication 
  • Appears before other general stomach upset symptoms 

These general and less specific symptoms include: 

  • Loss of appetite 
  • Nausea and vomiting 
  • Diarrhoea 
  • Constipation  
  • Inability to pass gas 
  • Fever 
  • Swelling of the abdomen 
  • The sensation to pass stool 

How is appendicitis diagnosed?

Apart from conducting a physical exam, I usually start off with basic tests like blood tests to check for signs of infection and urine tests to check for urinary tract infection. If necessary, I may order for imaging tests, such as: 

Abdominal ultrasound 

This allows me to look at the patient’s internal organs and check how blood is flowing through the different blood vessels 

CT scan 

A CT scan gives me detailed images of the body; in this case the appendix area 

MRI

I usually order for an MRI instead of CT scans for pregnant women as the former is safer 

What happens if I have appendicitis? 

Some doctors may prescribe antibiotics for less severe cases, but because it is likely the appendix will burst and cause a deadly infection, it is for this reason I advise all patients to undergo surgery. This surgery involves removing the appendix entirely either through: 

  • Open surgery, where a cut is made in the lower right area of the belly
  • Laparoscopic surgery, where several small incisions are made and a camera (laparoscope) is used to look inside the belly. This technique is preferred by most patients due to shorter recovery time. 

Can I wait to see if it’s just food poisoning or a stomachache?

It’s possible that the cause behind your abdominal discomfort is something less serious. But still, it’s better to be safe than sorry. I would advise to just get it checked out as appendicitis that goes untreated can result in septic shock and in rare cases death. 

References 

  1. Bhangu, A., Søreide, K., Di Saverio, S., Assarsson, J. H., & Drake, F. T. (2015). Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet (London, England), 386(10000), 1278–1287. https://doi.org/10.1016/S0140-6736(15)00275-5
  2. Perez, K. S., & Allen, S. R. (2018). Complicated appendicitis and considerations for interval appendectomy. JAAPA : official journal of the American Academy of Physician Assistants, 31(9), 35–41. https://doi.org/10.1097/01.JAA.0000544304.30954.40 

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