How to diagnose appendicitis

Written by Ren Zheng Xin
Gastroenterology
Updated on January 22, 2025
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Appendicitis is primarily diagnosed clinically through a physical examination. The patient is asked to lie flat, exposing the abdomen, with legs bent. The doctor stands on the patient’s right side and uses the right hand with fingers together to gently rub the abdomen, pressing on the McBurney's point. If there is significant pain, this is considered positive tenderness. Then, the doctor quickly lifts the fingers; if there is significant rebound pain, it is generally confirmed as acute appendicitis. During acute appendicitis, as the appendix lumen expands and the appendix becomes congested and edematous, ultrasound imaging can also show corresponding signs that serve as an auxiliary diagnosis. Once acute appendicitis is confirmed, it is mostly treated surgically.

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Does chronic appendicitis cause nausea?

Under normal circumstances, chronic appendicitis is characterized by recurrent discomfort and pain in the lower right abdomen. In terms of gastrointestinal symptoms, chronic appendicitis usually presents with bloating and indigestion, and rarely manifests symptoms such as nausea and vomiting. However, when chronic appendicitis undergoes an acute attack, it can also present gastrointestinal symptoms such as nausea and vomiting similar to those of acute appendicitis. Therefore, it can be said that chronic appendicitis can manifest gastrointestinal symptoms like nausea.

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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.

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Written by Ren Zheng Xin
Gastroenterology
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Is appendicitis prone to recurrence?

Appendicitis, if treated by surgically removing the appendix, generally does not recur and can be cured. However, if one only uses medication to control the symptoms during an attack of appendicitis, it can easily recur. For appendicitis, laparoscopic appendectomy is currently the preferred surgical treatment. This method involves less bleeding during surgery and quicker recovery post-surgery. For elderly or frail patients who cannot tolerate general anesthesia, the traditional surgical method involving an incision at McBurney's point can be chosen. With this method, it is important to rest more. Patients can usually be discharged about a week after surgery. Postoperative care should be strengthened, dietary adjustments should be made, and more vegetables should be eaten to prevent constipation.

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Written by Ren Zheng Xin
Gastroenterology
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Postoperative diet for acute appendicitis

Postoperative diet for acute appendicitis should be taken with special attention. On the day of the surgery, no food should be consumed. After waiting for anal gas to pass, which typically occurs on the first day post-surgery, a semi-liquid diet can be chosen, consisting of easily digestible foods such as rice porridge, millet congee, and vegetable soup. From the third to the fifth day post-surgery, a normal diet can be resumed, including eating eggs and meat to supplement proteins and dietary fibers, which help the incision heal. Vegetables and fruits should also be consumed to prevent constipation. Additionally, proper care should be taken of the incision site, including regular dressing changes.

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Early symptoms of appendicitis

What are the initial symptoms of appendicitis? It is characterized by abdominal pain. The main symptom is abdominal pain that appears around the upper abdomen or navel, and some patients may also experience nausea and vomiting. Generally, two to three hours later, the abdominal pain gradually shifts to the lower right abdomen, which we clinically refer to as migratory right lower abdominal pain. This symptom accounts for about 80% of clinical cases, while some patients present directly with pain in the lower right abdomen, without transitional abdominal pain. Therefore, the primary symptom of appendicitis is abdominal pain, as described in these two scenarios. However, physical examination is also very important, typically revealing localized fixed tenderness in the lower right abdomen as the main clinical manifestation.