Signs of appendicitis


Appendicitis usually manifests itself in the form of tenderness in the right lower abdomen.

Typical signs of appendicitis (appendicitis) are pain in the right lower abdomen, usually accompanied by fever, nausea, vomiting or constipation.

However, the classic signs are only found in about half of those affected, and it is not uncommon for small children and older people in particular to have different symptoms.

Signs of appendicitis

At the beginning of typical appendicitis (appendicitis) sufferers feel a dull, not exactly localizable pain (visceral pain) in the middle or upper abdomen, often around the navel (periumbilical). Thus, appendicitis is the most common cause of an acute abdomen (sudden abdominal pain). The pain migrates to the right lower abdomen within the first 8-12 hours and increases in intensity over time. There is also a change in quality to a burning pain that can be easily localized (somatic pain) on.
The location of the strongest pain reaction is typically in the McBurney Point. It is located halfway along an imaginary connecting line, between the right front iliac spine (Anterior superior iliac spine) and the navel.
In addition to the McBurney point, the Lanz point also has an increased sensitivity to pressure and knocking. The Lanz point lies between the right and middle third of an imaginary line connecting the two iliac spines.
A typical sign of appendicitis is also the so-called psoas pain, which can be provoked by bending the stretched leg against resistance. This can be explained by the anatomical proximity of the appendix and the fascia of the iliopsoas muscle ("Psoas muscle“).
However, if the appendix is ​​in the small pelvis, there is an increased sensation of pain when turning the right leg bent at the hip (Obturator sign).
Furthermore, a "Let go of pain“, Also known as the Blumberg sign, in the area of ​​the left lower abdomen, provoked by slowly pressing in and quickly letting go of the left lower abdomen.

Read also: This is how you can recognize appendicitis

Which test can I do myself?

Those who have abdominal pain can do some tests to see if it could be appendicitis. However, it must be said in advance that these tests cannot replace an examination by a doctor. In the case of pronounced abdominal pain, especially in the right lower abdomen, a doctor should be consulted who will, among other things, carry out an examination with several tests. You can also try some of these tests yourself with the help of another person.
The person concerned has to lie down on a hard surface as relaxed as possible. The second person presses the so-called McBurney point. This lies in the middle of the connecting line between the navel and the right protrusion of the hip bone. If this test causes pain, it could be a sign of appendicitis.
The Lanz point, which lies on the connecting line between the two upper protrusions of the hip bone between the right and middle thirds, can also be tested in the same way.
Another test that can indicate appendicitis if you are in pain is the psoas sign. To do this, the person affected must lie on their back and lift their right leg against resistance (the second person holds against).
However, all possible tests can only provide indications. A negative test doesn't rule out appendicitis and a positive test doesn't prove it. In addition, a lot of experience is necessary for a good assessment. The overall picture and the assessment by a doctor are also decisive. Therefore, in case of doubt, the family doctor should be consulted in good time or, if the pain is very severe, an emergency room should be consulted.

Also read our topic: Diagnosis and therapy of appendicitis

Can painful hopping be a sign?

Some people experience pain with appendicitis when they hop on their right leg. Especially in children, this can be a sign of appendicitis. The pain is caused when the appendix appendix is ​​behind the intestine. When jumping, a muscle is tensed there, which presses on the inflamed appendix and thus causes the pain. However, this symptom does not occur in many appendicitis.In addition, pain when jumping can also have other causes, such as discomfort emanating from the joints or muscles. If in doubt, especially for children who have pain when hopping on one leg, a doctor should be consulted promptly.

If you have any questions about the pain associated with appendicitis, read more about it at: Appendicitis pain

What can be signs of a ruptured appendix?

If appendicitis is not detected and treated in time, the appendix can burst, which can have life-threatening consequences. A typical sign of this is that the pain in the stomach initially gets worse and then suddenly subsides. The appendix, which is under strong pressure, causes the pain and when it bursts, the pain initially subsides. Another sign of this progression is when the pain increases again after a few hours. This can be explained by the fact that a ruptured appendix can inflame the peritoneum (Peritonitis) lining the abdominal cavity. In addition to diffuse pain throughout the abdomen, the abdominal wall can be tight as a board. It is an absolute emergency that requires surgery as soon as possible. However, an assessment of whether appendicitis could really be present or whether the organ has even burst cannot be made by a layperson, but can only be carried out by examination and questioning by a doctor.

Further information on this topic can be found at: Ruptured appendix

How do the signs differ in children from adults?

The signs of appendicitis in children can be the same as in adults. In small children in particular, however, the disease can present itself differently and other signs may appear. One of the reasons for this is that small children are less able to name and localize their symptoms. In adults, pain in the right lower abdomen (or pain that begins in the right upper abdomen and moves to the lower abdomen) is the most common sign of appendicitis. In children, unspecific abdominal pain (often indicated in the area of ​​the navel) can be the first sign. However, it can also be the case in children that they have no pain at all and that appendicitis can only be suspected based on other signs. Decreased activity, loss of appetite, and nausea and vomiting are possible signs.

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Other signs of appendicitis

Men may also experience pain in the testicles (testicular pain).
It is not uncommon for a symptom of appendicitis to be a low-grade fever of up to 38.5 degrees Celsius. Typically there is a difference between the rectal and armpit (axillary) measured temperature of more than one degree Celsius. A high fever is rather untypical for appendicitis and is an indication of another disease, or appendicitis with complications. In rare cases, accompanying chills can also occur. In addition, there is malaise and nausea, often accompanied by vomiting one or more times, approximately four to twelve hours after the onset of pain. Most often, people are constipated (Constipation), but more rarely diarrhea (Diarrhea) come.
If the pain suddenly eases during the course of the disease, it can be assumed that a so-called appendix rupture (perforation) took place. Peritonitis is a dreaded complication (Peritonitis), which can sometimes be life-threatening.
It should be noted that the typical signs of appendicitis can only be observed in about 50% of all those affected. Older people, small children but also pregnant women often show different symptoms and so-called atypical symptoms. Older people often have only minor symptoms. Therefore, the complication rate in these cases is significantly increased, since appendicitis is diagnosed later.
Even in pregnant women, the symptoms deviate from a typical course. The appendix is ​​due to pregnancy upwards or headwards (cranial) shifts and vomiting and nausea are in the foreground. Particular caution is required with small children, because of the rapid progression, high fever, frequent vomiting and a rapid increase in white blood cells (Leukocytosis) come.

Due to the great variability in the position of the appendix, the symptoms of appendicitis are often atypical. For example, with a so-called retrozecal appendicitis (located behind the large intestine) there is sometimes a disturbance in urination: It is shown by an increased frequency of emptying small amounts of urine (Pollakiuria). If the appendix is ​​in the small pelvis, the pain is primarily localized in the lower abdomen, but it can also radiate on the left (!!). There is also an increased need to stool and urinate.

Read more on the topic: Symptoms of appendicitis