Appendicitis Warning Signs: Belly Pain That Moves and When to Go to the ER

What it involves

MedlinePlus explains that appendicitis is a condition in which the appendix, a small pouch attached to the end of the large intestine, becomes inflamed. It is a very common reason for emergency surgery, and it most often happens when the appendix becomes blocked.

Who this is for

• Adults with new belly pain that started near the navel and is moving to the lower right
• People with belly pain, nausea and a low fever who are unsure whether to wait
• Older adults and women of childbearing age, in whom MedlinePlus says appendicitis can be harder to detect
• Family members who want to know the signs before they are needed

What to expect

• Questions about where the pain started, where it is now and what makes it worse, plus nausea, vomiting, fever and appetite
• An exam of the belly, including pressing the lower right side to check for tenderness
• A blood test for signs of infection when the exam alone is not clear
• A same-day referral to the emergency room for a CT scan or ultrasound and a surgeon's opinion when appendicitis is possible

How the pain behaves

MedlinePlus says the first symptom is often pain around the belly button or in the middle upper abdomen. It may be minor at first but becomes sharper and more severe, and it tends to move into the right lower part of the belly, usually 12 to 24 hours after the illness starts. The spot is directly above the appendix and is called McBurney point. Pain that is worse when you walk, cough or make sudden movements fits the pattern. The health topic page calls appendicitis a medical emergency and says it is more common among people 10 to 30 years old.

Other symptoms that travel with it

Loss of appetite, nausea, vomiting and a low-grade fever often come with the pain. Later symptoms include chills and shaking, diarrhea, fever and hard stools. The symptoms vary, and MedlinePlus warns that appendicitis can be hard to detect in young children, older people and women of childbearing age. A pattern that does not fit does not rule it out, so describe everything. Belly pain from other causes is covered in the abdominal pain guide and the fever in adults guide.

Why speed matters

MedlinePlus says most people recover quickly after surgery if the appendix is removed before it ruptures. If it ruptures first, recovery may take longer and problems become more likely: an abscess, blockage of the intestine, infection inside the abdomen called peritonitis, and infection of the surgical wound. That is the reason a suspected case is a same-day question rather than a wait-and-see week. The sick visit, urgent care or ER guide explains how to choose where to go.

How it is diagnosed

A provider suspects appendicitis from the symptoms and an exam, in which pain increases when the lower right belly is pressed. If the appendix has ruptured, even a light touch can cause a lot of pain and make the muscles tighten. A rectal exam may find tenderness on the right side, and a blood test will often show a high white blood cell count. A CT scan or ultrasound of the abdomen can help confirm it. Serenity By A Dr. Sareen does not list abdominal imaging among its in-office services, so scans are done at a hospital.

Treatment

Most of the time, a surgeon removes the appendix as soon as appendicitis is diagnosed. If a CT scan shows an abscess, antibiotics may come first, with the appendix removed after the infection and swelling have gone away. MedlinePlus adds that the tests are not perfect, so surgery sometimes shows a normal appendix, in which case the surgeon checks the rest of the abdomen for other causes of the pain. None of this happens in a primary care office, which is the reason to act early.

Pain that is probably something else

Not every right-sided pain is the appendix. Belly pain can come from the gallbladder, the bowel or a hernia. The gallstones and gallbladder pain guide, the diverticulitis guide and the hernia guide describe patterns that can look similar, and a provider sorts them out with an exam and, when needed, blood work and imaging. If the pain is getting worse, treat it as urgent rather than waiting for a pattern to settle. Upper belly pain with nausea and a poor appetite that builds over days or weeks, rather than hours, can instead come from an irritated stomach lining such as gastritis, and the Belle Glade primary care office can evaluate that kind of pain at a visit.

Sources

• MedlinePlus: Appendicitis (medical encyclopedia)
• MedlinePlus: Appendicitis (health topic)