What tests are done for appendicitis?

Written by Ren Zheng Xin
Gastroenterology
Updated on April 19, 2025
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Appendicitis examination primarily involves a physical examination. The patient lies flat with their legs bent, and the doctor stands on the patient's right side. The patient exposes their abdomen, and the doctor places their right palm flat in the middle of the abdomen, then smoothly performs a clockwise palpation, pressing the abdomen to check for rebound tenderness, especially at McBurney's point. If there is significant tenderness and rebound pain at McBurney's point, along with symptoms of fever and nausea, appendicitis is generally considered. An ultrasound can also be used as an auxiliary examination, where swelling of the appendix can be observed. Based on the physical examination and auxiliary tests, a preliminary diagnosis of appendicitis can be made.

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General Surgery
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Should you avoid certain foods if you have chronic appendicitis?

The majority of chronic appendicitis is transformed from acute appendicitis after treatment. Clinically, it mainly manifests as recurrent pain and discomfort in the lower right abdomen. In cases of chronic appendicitis, it is important to pay attention to a reasonable diet, avoid overeating and the consumption of gastrointestinal irritants, including spicy foods and some hard, cold foods, as these can induce pain in the lower right abdomen. Additionally, the diet should be low in sodium, sugar, and fat. Consumable options may include liquid or semi-liquid foods, as well as foods like yogurt. It is also advisable to eat fruits and vegetables rich in vitamins and anti-inflammatory substances, such as apples, bananas, cabbage, and cauliflower.

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Written by Ren Zheng Xin
Gastroenterology
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Acute appendicitis clinical classification

Acute appendicitis can be classified into four types based on the clinical course. The first type is acute simple appendicitis, where the lesions are mostly confined to the mucosa and submucosal layer, with small ulcers and bleeding spots on the mucosal surface. The symptoms and signs are relatively mild. The second type is acute suppurative appendicitis, where the lesion has spread through all the layers of the appendix wall, and pus may accumulate inside, also known as acute cellulitis appendicitis. The third type is gangrenous and perforated appendicitis, which occurs due to pus in the appendix cavity causing increased internal pressure and circulatory disturbances in the appendix wall, leading to mucosal ischemic necrosis and perforation, causing acute diffuse peritonitis. The fourth type is peri-appendiceal abscess, which forms an inflammatory mass encapsulated by the surrounding omentum during suppuration or perforation of acute appendicitis.

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Gastroenterology
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How long does acute appendicitis hurt?

The pain associated with appendicitis is directly related to the severity of the inflammation. If the inflammation is mild, pain can be significantly relieved after using antispasmodic analgesics. However, if acute appendicitis leads to a suppurative appendix or perforation, the abdominal pain will last for a very long time, accompanied by signs of peritoneal irritation, such as tenderness and rebound pain in the abdomen. Therefore, the main principle of treating acute appendicitis is to perform surgery to remove the suppurative appendix. Currently, laparoscopic appendectomy is a viable option, as it involves less bleeding and allows for a faster postoperative recovery.

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General Surgery
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Diagnosis methods for chronic appendicitis

The diagnostic methods for chronic appendicitis mainly include medical history, clinical symptoms, physical examination, laboratory tests, and auxiliary examinations. Firstly, cases of chronic appendicitis generally have a history of acute appendicitis episodes. Clinically, it is mainly characterized by pain, discomfort, and dull pain in the lower right abdomen, often without a history of migratory lower right abdominal pain. In physical examinations, tenderness can be found in the lower right abdomen, and when chronic appendicitis flares up acutely, signs of peritonitis can manifest as rebound pain in the lower right abdomen. In laboratory tests, an increased white blood cell count can be observed. Auxiliary examinations may reveal thickening of the appendix wall and obstruction in the appendix lumen due to fecaliths. Therefore, chronic appendicitis can be diagnosed through methods such as medical history, clinical symptoms, physical examination, laboratory tests, and auxiliary examinations.

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Characteristics of Appendicitis Pain

The most typical pain manifestation of appendicitis is migratory pain, which generally starts in the upper abdomen or around the navel, and in most cases moves to the lower right abdomen and becomes fixed within a few hours. During physical examination, the pain usually localizes to a fixed point in the lower right abdomen, typically at McBurney's point, although this can vary with the position of the appendix. However, as the condition of the appendix progresses, such as when it becomes purulent or even gangrenous, the inflammation worsens and the area of tenderness can expand. This is mostly manifested by symptoms of peritoneal irritation, which are generally indicative of the timing for surgery. In most cases of appendicitis where the diagnosis is clear, early surgical intervention is recommended, as surgery is the only cure. Most patients who improve with conservative treatment are likely to experience recurrence later on.