What Are the Early Warning Signs of Appendicitis?

Severe pain in the lower right abdomen is usually the first sign of appendicitis. This is a medical emergency and you should see a doctor right away if you suspect you have appendicitis.

The appendix is a long finger-like tube connected to the first part of the large intestine (the colon). When the appendix becomes inflamed and infected, this is referred to as appendicitis. When appendicitis occurs, the appendix can swell and may burst, which can cause infection in the abdomen.

In the U.S., more than 5% of the population will develop appendicitis at some point in their lives, and it is the most common cause of acute abdominal pain requiring surgery. It most commonly occurs in teenagers and young adults in their twenties but it can occur at any age.

Early warning signs of appendicitis include: 

• Severe pain in the lower abdomen, on the right side
  • Pain is usually the first symptom
  • The pain often starts near the belly button and moves toward the lower right side
  • Pain occurs rapidly and gets worse in a matter of hours
  • Pain is worse when you take deep breaths, cough, sneeze, or move
  • Is often severe

Common symptoms of appendicitis include:

• Loss of appetite
• Nausea and vomiting
• Fever
• Stomach upset
• Increased gas (flatulence) or an inability to pass gas
• Irregular bowel movements
• Abdominal bloating
• Diarrhea
• Feeling ill (malaise)
• Constipation

Call a doctor right away or get to a hospital’s emergency department if you have symptoms of appendicitis. The risk of the appendix bursting increases after the first 24 hours of symptoms, and if the appendix bursts, surgery to treat it is more complicated.

Causes of appendicitis may include:

• Blockage of the lining of the appendix
• Infection in the gastrointestinal (GI) tract or elsewhere in your body that results in swollen tissue in the wall of the appendix
• Inflammatory bowel disease (IBD)
• Stool, parasites, stones or growths that can block the appendiceal lumen
• Abdominal trauma

Appendicitis can sometimes be diagnosed with a physical exam. The doctor will press on the abdomen to check for tenderness in the lower right part side and swelling or rigidity.

Tests to confirm appendicitis or rule out other conditions may include:

• Computerized tomography (CT) scan
• Abdominal ultrasound
• Magnetic resonance imaging (MRI)
• X-ray of the abdomen
• Blood tests 
  • Complete blood count (CBC)
• Urine tests to rule out kidney stones or urinary tract infection (UTI)
• Chest X-ray or CT scan to rule out pneumonia
• In women:
  • Pregnancy test 
  • Pelvic exam to rule out ovarian cysts or pelvic inflammatory disease 
  • Transvaginal ultrasound

If the appendix has not burst, it may be possible to treat the appendicitis with antibiotics, but without surgery there is a chance appendicitis will return so surgery is usually recommended.

Surgical removal of the appendix (appendectomy) is performed in two ways:

• Open surgery in which an incision is made near the appendix big enough to pull the appendix through
• Laparoscopic surgery in which a few smaller incisions are made and a long, thin tool with a camera on the end is inserted into the abdomen (a laparoscope)

If the appendix has burst, surgery is usually more complicated and cuts might be larger or the surgery might take longer.

Complications of untreated appendicitis include:

• Ruptured appendix that can cause peritonitis, a potentially life-threatening condition in which infection spreads in the abdomen causing:
  • Fever
  • Nausea
  • Vomiting
  • Severe abdominal tenderness
  • Death in some cases
• Appendiceal abscess
• Abdominal adhesions
• Chronic abdominal pain
• Bowel obstruction
• Urinary tract obstruction