A physical exam, a medical history, and appendicitis tests, such as x-rays or a CT scan are all part of the process when making an appendicitis diagnosis. In some cases, a laparoscopy may be necessary to confirm the condition. This procedure avoids radiation, but requires general anesthesia.
To help in making an appendicitis diagnosis, the doctor will ask a number of questions about a patient's medical history, perform a physical exam, and order certain tests.
A medical history of a patient's symptoms is often the key to diagnosing appendicitis. The medical history should include questions about the nature, timing, location, pattern, and severity of the pain and other possible symptoms. It is important for patients to tell their doctor about:
- Any previous medical conditions and surgeries
- Any previous family history of medical conditions and surgeries
- Use of alcohol, tobacco, and any other drugs.
This medical history is considered confidential and cannot be shared without the patient's express permission.
Before the physical examination, a nurse or doctor will usually measure vital signs, which include:
- Pulse rate
- Breathing rate
- Blood pressure.
Many conditions, such as pneumonia or heart disease, can cause abdominal pain (stomach pain), and generalized symptoms such as fever, rash, or swelling of the lymph nodes may point to diseases that would not require surgery. Examination of the abdomen and the location and tenderness of the pain can help pinpoint the diagnosis.
Two signs, called peritoneal signs, will suggest that the lining of the abdomen is inflamed and surgery may be needed: rebound tenderness and guarding. Rebound tenderness occurs when the doctor presses on a part of the abdomen and the patient feels more tenderness when the pressure is released than when pressure is applied. Guarding refers to the tensing of muscles in response to touch.
During the physical exam, the doctor may also move the patient's legs to test for pain on flexion of the hip (called psoas sign), pain on internal rotation of the hip (obturator sign), or pain on the right side when pressing on the left (Rovsing's sign). These signs of pain are valuable indicators of inflammation that are helpful when diagnosing appendicitis.