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Chris wasn’t feeling well. He didn’t have pain, really; his belly just didn’t feel right. He figured it was gas pains, and tried going to the bathroom, but it didn’t make much difference, and he thought it would just go away in a little while. He slept okay, but woke up still with a vague, crampy sensation in the middle of his abdomen. He also felt both warm and a bit chilled. At breakfast, he had a few bites, then realized he wasn’t actually hungry. The discomfort in his abdomen got more noticeable over the next few hours, and close to lunchtime, he felt just a little nauseated and feverish. He decided to go to the emergency room.
When the doctor asked Chris where the pain was and when it started, he indicated all over the center part of his abdomen, and said it only got bad this morning. On further questioning, they both realized his symptoms had actually started the day before. And when the doctor pushed gently over Chris’ lower right abdomen, it really hurt. The doctor told Chris he likely had appendicitis, and that he would get a special X-ray study, called a CT scan (commonly referred to as “CAT scan”), to confirm the diagnosis.
#1: Vague central abdominal discomfort that moves to become pain in the right lower abdomen
The appendix is a small, short, tubular part of the intestine (in the midgut) that sticks out where the small intestine and large intestine (colon) join, in the lower right corner of the abdominal cavity. It doesn’t have nerves that feel pain, so when it gets blocked by a piece of stool or a swollen lymph node and begins swelling, the stretch is felt as a general, vague uncomfortable feeling in the center of the abdomen, near the belly button. Problems higher up in the small intestine (in the foregut) lead to pain just under the center of the rib cage at the top of the abdomen, and problems further along in the colon (in the hindgut) get referred as pain centered over the pelvis or lower abdomen. It isn’t until the appendix becomes inflamed enough to irritate the lining of the abdomen — the peritoneum — which does have nerves that feel pain, that we feel the pain exactly where the problem is, usually in the lower right abdomen. This is when most people get concerned, but the first signs of appendicitis are frequently vague and often dismissed as “bad food,” gas pains, or just a few cramps.
#2: Lack of appetite, or anorexia
Once appendicitis begins, the intestines generally do not want to work normally. Your body tells you, “I don’t want food right now,” and you don’t feel hungry. In children especially, if they wouldn’t even want to eat their favorite food, and they are complaining of abdominal pain and any of the symptoms below, suspicion for appendicitis might be higher.
#3: Nausea and/or vomiting
With appendicitis, pain or discomfort almost always comes before vomiting. If you have nausea and vomiting followed by pain, it is much less likely to be caused by your appendix. And though not every patient has these symptoms, many patients with appendicitis do feel like throwing up, whether they do or not. This goes along with not being hungry. Another possible symptom is diarrhea, which signifies the intestines are irritated and trying to empty themselves.
#4: Fever or chills
As the infection progresses, many patients feel hot and have temperatures a little or a lot higher than normal. Some patients experience chills instead, and feel cold or have shivers, when others around them do not. Sometimes, it is possible to feel chilled and have a fever at the same time. Whether the cause is appendicitis or not, these symptoms are a good reason to call or see your doctor to get checked out.
#5: Pain in the abdomen when going over bumps while in the car, or when jumping up and down
Pain with movement or shaking of the abdomen is an indicator of peritonitis, or inflammation of the peritoneal lining. This is usually a later sign of appendicitis, once the appendix is itself inflamed or infected enough to irritate the peritoneum, at least locally. If the pain extends outside the lower right abdomen, it could be a sign that the appendix has ruptured, or broken open, and infected fluid or pus is present in the abdominal cavity. In some patients, their pain gets worse and worse, and then it suddenly gets better or completely goes away. This is actually a bad sign, and may also indicate rupture of the appendix, as the pain due to the pressure building up in the swollen appendix is relieved when it opens, leaking infected contents into the abdomen.
Chris’ story is fairly typical for a patient with appendicitis, and his CT scan did show that his appendix was inflamed, but there were no signs of rupture or abscess. He was taken for surgery to remove his appendix, and was able to start eating again and leave the hospital soon after. Since there is nothing you can do to cause or prevent appendicitis, knowing these signs and symptoms may help you to suspect it early, seek medical and surgical evaluation, and avoid more extensive problems that can occur if the appendix ruptures before it can be removed.