Appendicitis occurs more frequently in men than women (3:2) and usually occurs in the second or third decade of life. Due to a number of factors, diagnosing acute appendicitis is more difficult in children under 3 years of age and in adults older than 60. Unfortuantely, this can result in a ruptured appendix if not caught in a timely manner.

There are some classic symptoms associated with appendicitis but that being said, the symptoms are fairly vague at first. The pain starts generally around the umbilicus (belly button) which then tends to radiate down to the right side of the abdomen. Loss of appetite (anorexia) and nausea almost always accompany the pain.

Now, many people complain of abdominal pain or discomfort with loss of appetite and nausea so the clinician looks for other symptoms that may help confirm the diagnosis. These are:

• guarding the abdomen voluntarily or involuntarily during the exam
• heart rate over 100
• slight temperature increase
• pain that is relieved with bending the right lower leg

Sometimes however, the symptoms are not so clear cut and can include:

• diarrhea, gas or indigestion
• general  malaise

Because symptoms can be vague especially at the onset, there is no one specific test used to diagnose appendicitis. Labs can be ordered to see if the white blood count is elevated or to rule out other causes of abdominal pain. CT scans and ultrasound testing can be useful when appendicitis is suspected but not clear. 

Even then, these radiologic exams can be less than clear. Case in point involved one patient of mine whose CT results were equivocal. The surgeon wanted to monitor her overnight to see if her symptoms worsened but she had had enough and decided she wanted to proceed with the surgery. Sure enough, the pathology report showed inflammation of the appendix.

Hopefully, a thorough history, physical and lab data can cinch the diagnosis - if not there are the radiologic tests previously mentioned. Otherwise, careful observation in a hospital setting may be required.