Diagnosis of Appendicitis

How do doctors diagnose appendicitis?

To diagnose appendicitis, your doctor will review your symptoms and medical history, perform a physical exam, and order lab tests and imaging tests.

Medical history

Your doctor will ask questions to help rule out other health problems. Your doctor will want to know

• when your abdominal pain began, how bad it feels, and where exactly you feel it
• when your other symptoms started
• what other medical conditions, illnesses, and operations you’ve had
• whether you use medicines or alcohol

Physical exam

During the physical exam, your doctor will check for pain in your lower-right abdomen. Your doctor may

• gently press or jiggle all areas of your abdomen
• press your right knee as you lift your leg
• flex and rotate your leg while you lie on your left side

Your doctor may also

• listen to your abdomen using a stethoscope
• do a digital rectal exam
• do a pelvic exam

Lab tests

To find out whether your abdominal pain is appendicitis or not, your doctor may order a

• blood test, which may show if you have a high white blood cell count—a sign of infection. Your blood test also may show if you have dehydration or if any fluids or electrolytes are out of balance.
• c-reactive protein (CRP) blood test to find other causes of inflammation.
• urinalysis to rule out other conditions, such as a bladder infection or a kidney stone.
• pregnancy test, if you’re a woman.

Imaging tests

Your doctor may use imaging tests to find out if your pain is caused by appendicitis.

• Abdominal ultrasound uses sound waves to create an image of your internal organs. An ultrasound doesn’t use x-rays and doesn’t expose you to radiation. Doctors use an ultrasound as the first imaging test when checking for possible appendicitis in infants, children, young adults, and pregnant women.
• Magnetic resonance imaging (MRI) scan takes pictures of your body’s internal organs and soft tissues without using x-rays. Doctors can use an MRI scan as a safe, reliable alternative to a computed tomography (CT) scan.3
• Computed tomography (CT) scan combines x-rays and computer technology to create images. If you’re a woman of childbearing age, you should have a pregnancy test before having a CT scan. The radiation from CT scans can be harmful to a developing fetus. In children, to decrease radiation exposure, a CT scan is recommended only after ultrasound and MRI.

Imaging tests can show whether your abdominal pain is caused by a blockage inside the appendix, an enlarged or burst appendix, inflammation, an abscess, or something else.

Imaging tests can also show if your abdominal pain and other symptoms are not caused by appendicitis, but rather by other conditions such as

• abdominal adhesions
• inflammatory bowel disease, including long-lasting disorders such as Crohn’s disease and ulcerative colitis
• intestinal obstruction
• pelvic inflammatory disease
• kidney stones
• problems with the reproductive system in women

References

[3] Mervak BM, Wilson SB, Handly BD, Altun E, Burke LM. MRI of acute appendicitis. Journal of Magnetic Resonance Imaging. 2019;50(5):1367–1376. doi:10.1002/jmri.26709

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