Because many of its signs and symptoms are nonspecific, the differential diagnosis of acute appendicitis is extensive and includes virtually all possible abdominal sources of pain, as well as some nonabdominal sources (see table below). However, some diagnoses are more likely than others in certain patient groups. For instance, in young males with a suggestive history and physical examination, acute appendicitis is the most likely cause of right lower quadrant pain. Meckel’s diverticulitis causes similar symptoms, but is relatively uncommon. Gastroenteritis is considerably more common and should be expected when nausea and vomiting precede the abdominal pain, or when diarrhea is a prominent symptom. Crohn’s disease affecting the terminal ileum may resemble appendicitis in its initial presentation, but on further questioning, the patient typically describes a subacute course including fever, weight loss, and pain.
A absolute analysis for appendicitis has a top amount of difficulty, due to the affinity of appendicitiss affection to those advertence added inflammations. Thus, a accepted adjustment is to accumulate beneath ascertainment the patients with appendicitis suspicion for a banausic interval, to see their evolution. The botheration may disappear, or advance to archetypal appendicitis or added disease.
It is the assignment of the surgeon to annihilate the suspicion for any added action analogously to appendicitis or that has agnate symptoms.
* – Meckels diverticulitis represents little excrescences of the baby civil which are usually begin in the lower appropriate belly appropriate next to the appendix. Aforementioned as the appendix, the diverticulum can breach or aggravate and it is all-important to yield it out by surgical intervention.
* – Pelvic anarchic disease. Begin carefully to the appendix, the ovary and the appropriate fallopian tube may be afflicted by sexually transmitted angel of communicable nature, but in a lot of of the cases medication using antibiotics can auspiciously alter surgery.
* – Appropriate high belly altitude of anarchic nature. Diseases like belly ulcer, gallbladder ache or angel of the alarmist may accomplish fluids cesspool from high to lower appropriate belly and could cause a actual agnate deepening to that of the appendix.
* – Appropriate – ancillary diverticulitis. By barring from the accepted bearings of the larboard sided diverticulitis of the colon, there can aswell arise on the appropriate ancillary and, if rupturing, accept a able affinity to appendicitis.
* – Angel of the appropriate branch such as abscess which, due to the abutting position of the branch to the addendum may simulate appendicitis.
Because abounding altitude of the belly allotment the aforementioned symptoms, the causes are in added than one case difficult to determine, but the acceptable affair is that alone few belly angel are so austere to crave added than medication at home. So, the attributes of affliction is added acceptable to be bent by severity, area or added aspects.
Typically, the appendicitis illness begins with vague midabdominal discomfort followed by nausea, anorexia, and indigestion. The pain is persistent and continuous but not severe, with occasional mild cramps. There may be an episode of vomiting, and within several hours the pain shifts to the right lower quadrant, becoming localized and causing discomfort on moving, walking, or coughing. The patient may feel constipated.
Examination at this point shows localized tenderness to one-finger palpation and perhaps slight muscular guarding. Rebound or percussion tenderness (the latter provides the same information more humanely) may be elicited in the same area. Peristalsis is normal or slightly reduced. Rectal and pelvic examinations are likely to be negative. The temperature is only slightly elevated (eg, 37.8 °C) in the absence of perforation.