Where does appendicitis hurt?

Written by Zhang Peng
General Surgery
Updated on April 21, 2025
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In general clinical practice, the pain associated with appendicitis mostly occurs in the lower right abdomen. Some patients experience very typical migratory right lower abdominal pain which usually starts in the upper abdomen, gradually moves around the navel, and finally localizes in the lower right abdomen. Direct pain in the lower right abdomen could also be indicative of appendicitis. In rare cases, if there is a reversal of organs or an abnormal position of the appendix, pain may occur in the upper right abdomen or lower abdomen as well. For pregnant women, the appendix may be positioned higher and could cause pain under the rib cage. Therefore, the diagnosis of appendicitis should be based on the specific condition of the patient and related diagnostic tests.

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Does appendicitis cause vomiting?

Appendicitis can cause vomiting. An acute appendicitis attack presents with distinct symptoms such as severe abdominal pain, high fever, nausea, and vomiting. The main reason is the inflammation of the appendix lumen, which reflexively causes vomiting. For appendicitis, once diagnosed, surgery is generally required. Currently, there are two surgical approaches: laparoscopic appendectomy and appendectomy via McBurney's point. Laparoscopic appendectomy is more common and involves less intraoperative bleeding and faster postoperative recovery. Postoperatively, it is important to enhance nursing care by eating more vegetables, drinking plenty of water, and ensuring that stools are softened.

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What should I do if I have appendicitis pain?

Appendicitis should first be diagnosed and treated at the general surgery outpatient clinic. The doctor will perform relevant examinations based on symptoms and signs, such as complete blood count, C-reactive protein, and ultrasound of the lower right abdomen, among others. Based on the results of these tests, the doctor will make an appropriate judgment about the condition. Generally, surgery is advocated for acute appendicitis. If the inflammation is not severe, conservative treatment, primarily focusing on anti-inflammatory treatment, may also be an option. Severe acute appendicitis poses a risk of perforation, and timely hospitalization for surgical treatment is recommended. Chronic appendicitis should also be managed based on specific symptoms, signs, and related examinations, with early surgery performed if possible to prevent recurrent episodes.

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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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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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Can appendicitis be contagious?

Appendicitis is a nonspecific inflammation occurring in the lumen of the appendix. It is not contagious, therefore, it is not an infectious disease. Once appendicitis is diagnosed, it is mostly treated surgically because the main blood supply to the appendix is the appendicular artery, which can easily lead to ischemic necrosis during inflammation. If controlled solely by medication, symptoms are likely to recur easily. Currently, appendectomy is commonly performed using minimally invasive techniques, under laparoscopy, which results in less bleeding during surgery and faster recovery afterward. Generally, if there is no suppuration or perforation, patients can be discharged three days after surgery. Postoperative care should be enhanced, including eating more vegetables to prevent constipation.