Acute Appendicitis Quiz
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Abdominal pain
Lower right abdominal pain
Loss of appetite
Throwing up blood
Stomach ache
Throwing up
Stomach hurts when pressed down
Left side abdominal pain
Nausea and vomiting
Chills and fever
Chills but no fever
Stomach ache and vomiting
Not seeing your symptoms? No worries!
What is Acute Appendicitis?
Acute appendicitis happens when the appendix (a small, tube-like structure attached to a part of the colon) gets inflamed. This usually occurs because the appendix gets clogged with fecal material or calcium. The appendix swells with inflammation and becomes infected with gut bacteria. It can affect anyone and is most common in young adults.
Typical Symptoms of Acute Appendicitis
- Stomach or abdominal pain with the abdomen becoming hard when gently pressed
- Stomach or abdominal pain in a specific area
- Constipation with urge to go but unable to pass stool
- Frequent stomach or abdominal pain with unknown causes
- Pain in the lower right abdomen
- Whole body pain
- Stomach or abdominal pain
- Stomach pain that worsens when the stomach is pressed
Diagnostic Questions for Acute Appendicitis
Your doctor may ask these questions to check for this disease:
- Do you have stomach or abdominal pain with your abdomen becoming hard when gently pressed?
- Do you have stomach or abdominal pain in a specific area?
- Do you have constipation where you feel the urge to go but can't pass stool?
- Do you have frequent stomach or abdominal pain with unknown causes?
- Do you have pain in the lower right abdomen?
Treatment of Acute Appendicitis
Acute appendicitis is often treated surgically by removing the appendix. Antibiotics and pain medications are often administered as well, and in cases where surgery is deemed not appropriate.
Reviewed By:
Maxwell J. Nanes, DO (Emergency Medicine)
Dr Nanes received a doctorate from the Chicago College of Osteopathic Medicine and went on to complete a residency in emergency medicine at the Medical College of Wisconsin. There he trained at Froedtert Hospital and Children's Hospital of Wisconsin in the practice of adult and pediatric emergency medicine. He was a chief resident and received numerous awards for teaching excellence during his time there. | | After residency he took a job at a community hospital where he and his colleagues worked through the toughest days of the COVID-19 pandemic. |
Aiko Yoshioka, MD (Gastroenterology)
Dr. Yoshioka graduated from the Niigata University School of Medicine. He worked as a gastroenterologist at Saiseikai Niigata Hospital and Niigata University Medical & Dental Hospital before serving as the Deputy Chief of Gastroenterology at Tsubame Rosai Hospital and Nagaoka Red Cross Hospital. Dr. Yoshioka joined Saitama Saiseikai Kawaguchi General Hospital as Chief of Gastroenterology in April 2018.
Content updated on Nov 15, 2024
Following the Medical Content Editorial Policy
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Symptoms Related to Acute Appendicitis
Diseases Related to Acute Appendicitis
FAQs
Q.
Appendicitis in Women: 7 Warning Signs & Your Urgent Action Plan
A.
Know the 7 warning signs of appendicitis in women and when to act: abdominal pain that shifts to the lower right and intensifies, sudden loss of appetite, nausea or vomiting after pain starts, low fever or chills, bowel changes, pelvic or lower back pain, and pain that worsens with movement or touch. If these symptoms are worsening, do not wait: take them seriously, seek urgent medical care, avoid laxatives and heating pads, and consider a trusted symptom checker while arranging care; doctors confirm with exams, blood tests, and imaging. There are several factors to consider, including overlap with menstrual, ovarian, or urinary issues and atypical signs in pregnancy or older adults; see the complete action plan and important details below.
References:
* Smith, H. L., & Busey, A. (2022). Acute Appendicitis in Women: Presentation, Diagnosis, and Management. *Current Problems in Surgery*, *59*(6), 101168.
* Shaikh, I. A., & Bakhsh, T. (2022). Acute Appendicitis in Women: A Comprehensive Review of Diagnostic Challenges and Management Strategies. *International Journal of Surgery Open*, *42*, 100465.
* Andrade, R. S., Bessa, B. B., Siqueira, L. T. P., Parente, D. B., Vasconcelos, G. M. B., Cavalcante, B. B., ... & Garcia, J. H. M. (2023). Diagnostic challenges of acute appendicitis in females of childbearing age: a retrospective review. *International Journal of Surgery Global Health*, *6*(2), e116.
* Memon, M. Z., Malik, M. F., Tariq, S., Zaidi, R., Shaikh, N. M., & Khan, M. F. (2023). Acute appendicitis in female patients: a diagnostic conundrum. *Annals of Medicine & Surgery*, *85*(2), 526-530.
* Wagner, A. H., Tappe, E., Wierlemann, A., & Spang, T. (2023). Atypical Appendicitis—An Underestimated Challenge? *Journal of Clinical Medicine*, *12*(7), 2686.
Q.
Appendicitis in Women: Signs You Can’t Ignore & Next Steps
A.
Key signs include belly-button pain that shifts to the lower right abdomen, worsens with movement, and is often joined by loss of appetite, nausea or vomiting, low fever, and bowel or bladder changes, which can be confused with gynecologic issues or appear higher during pregnancy. Do not wait: seek urgent care for severe or worsening right-sided pain, fever, rigid belly, persistent vomiting, or sudden pain relief followed by worse symptoms, since appendicitis does not resolve without treatment and usually needs prompt imaging and surgery; there are several factors to consider, and the complete next steps and special cases are explained below.
References:
* Sharma V, Singh M, Kaur S, et al. Acute appendicitis in women: a diagnostic challenge. Int J Surg. 2017 Mar;39:107-112. doi: 10.1016/j.ijsu.2017.01.077. Epub 2017 Jan 31. PMID: 28163098.
* Kokavec R. Gender differences in symptoms and signs of acute appendicitis. Scand J Surg. 2019 Jun;108(2):105-109. doi: 10.1177/1457496918797864. Epub 2018 Sep 21. PMID: 30241354.
* Hale L, Johnson J, Mclean S, et al. Imaging for Acute Appendicitis in Women: Current Status and Future Directions. AJR Am J Roentgenol. 2021 Mar;216(3):575-585. doi: 10.2214/AJR.20.24157. Epub 2020 Nov 18. PMID: 33206413.
* Nishimura M, Tsuboi A, Ito T, et al. Diagnostic accuracy of Alvarado score in acute appendicitis among women of childbearing age. World J Emerg Surg. 2017 Mar 21;12:15. doi: 10.1186/s13017-017-0128-z. PMID: 28337299; PMCID: PMC5360980.
* Li Y, Li M, Ma L, et al. Clinical features, misdiagnosis and complications of acute appendicitis in women of childbearing age: a retrospective study. BMC Womens Health. 2023 Mar 1;23(1):50. doi: 10.1186/s12905-023-02195-2. PMID: 36859353; PMCID: PMC9978716.
Q.
Appendix Symptoms in Women: Vital Signs & Your Action Plan
A.
Appendix symptoms in women often start with dull belly-button pain, nausea or loss of appetite, and a low-grade fever, then typically shift to sharper right lower abdominal pain that worsens with movement; pain can feel pelvic, mimic period or urinary issues, and in pregnancy can appear higher in the abdomen. Seek urgent care for pain that worsens over 6 to 24 hours, right lower abdominal pain with fever or vomiting, or any abdominal pain in pregnancy, and use the action plan to track patterns, avoid masking severe pain, consider a symptom check, and speak with a doctor promptly. There are several factors to consider; key details that can influence your next steps are explained below.
References:
* Guler Y, Celik A. Diagnostic accuracy of clinical decision rules for acute appendicitis in women: a systematic review and meta-analysis. Ann Med Surg (Lond). 2020 Jul 15;56:229-236. doi: 10.1016/j.amsu.2020.06.012. PMID: 32661036; PMCID: PMC7359567.
* Singh A, Singh P, Kour H, Kohli K, Kaur M, Kalia S, Bhagat M. Acute appendicitis in women of childbearing age: A diagnostic challenge. Int J Surg. 2018 Jun;54(Pt A):110-112. doi: 10.1016/j.ijsu.2018.04.048. Epub 2018 Apr 23. PMID: 29775086.
* Benigni C, Benigni B, Malaguti S, Ciappina A, D'Ambrosio V, Tassi N, Calistri L, Scaglione M. Differential diagnosis of right lower quadrant pain in women: A systematic review. Radiol Med. 2020 Dec;125(12):1299-1309. doi: 10.1007/s11547-020-01254-4. Epub 2020 Sep 18. PMID: 33281090; PMCID: PMC7685652.
* Wu M, Chen Y, Wang M, Li J, Guo Y. Delay in diagnosis of acute appendicitis in women: a systematic review. Int J Clin Exp Med. 2018 Apr 15;11(4):2877-2884. eCollection 2018. PMID: 29875417; PMCID: PMC5987483.
* Kulacoglu H. Management of acute appendicitis in women: current perspectives. Ther Clin Risk Manag. 2019 Mar 12;15:377-384. doi: 10.2147/TCRM.S164724. PMID: 30883210; PMCID: PMC6418854.
Q.
Appendix Symptoms Women 30-45 Must Know & Vital Next Steps
A.
In women 30 to 45, appendicitis often begins as pain near the belly button that shifts to the lower right abdomen and steadily worsens, with nausea or vomiting, low fever, loss of appetite, bloating, and pain that increases with movement, which can mimic ovarian cysts, endometriosis, fibroids, PID, IBS, or menstrual cramps. If pain is severe or escalating, especially with fever over 100.4 F, persistent vomiting, a rigid belly, or sudden relief then worsening, seek urgent care now; there are several factors and vital next steps to consider including what to avoid, how it is diagnosed and treated, and pregnancy specific guidance, so see the complete details below.
References:
* Özdemir, H., et al. "Diagnostic dilemma of acute appendicitis in women of childbearing age: a retrospective analysis." *Langenbeck's Archives of Surgery*, 2018; 403(1): 117-124.
* Al-Omran, M., et al. "Acute appendicitis in women: pitfalls in diagnosis." *Canadian Journal of Surgery*, 2017; 60(5): E1-E5.
* Chang, J. H., et al. "Clinical characteristics and diagnostic performance of imaging studies in female patients with suspected appendicitis." *Journal of Korean Medical Science*, 2020; 35(15): e109.
* Podda, M., et al. "Acute appendicitis: a systematic review of the diagnostic strategies in difficult-to-diagnose patients." *Journal of Clinical Medicine*, 2021; 10(9): 1888.
* Hwang, J. J., et al. "Diagnostic utility of ultrasound and CT in women with suspected acute appendicitis." *BMC Medical Imaging*, 2019; 19(1): 27.
Q.
Appendicitis in Women 65+: Subtle Signs You Must Not Ignore
A.
Appendicitis in women over 65 often presents with subtle, atypical symptoms that are easy to miss, including mild or diffuse belly discomfort, bowel habit changes, nausea without vomiting, urinary urgency, low or no fever, and unexplained fatigue. Because diagnosis can be delayed in this age group, prompt evaluation for persistent or worsening symptoms is important to prevent rupture and serious infection. There are several factors to consider, from medications and other conditions that mask signs to the exact red flags, timelines, tests, and treatments; see below for the complete answer and guidance on what to do next.
References:
* Yu CW, Huang CW, Lin KC, Wang YC, Cheng CY, Chang YT, Lee CC. Acute appendicitis in the elderly: a diagnostic challenge. Ulus Travma Acil Cerrahi Derg. 2013 Nov;19(6):528-32. PMID: 24272183.
* Podda M, Evola S, Formisano G, Loi F, Micali G, Mura G, Melis L, Pisanu A. Acute appendicitis in the geriatric population: a systematic review. Int J Surg. 2021 Mar;87:105869. PMID: 33549725.
* Almaramhi T, Balakrishnan K, Raftery G, Lawton J, Sanyal S. Challenges in the diagnosis of appendicitis in older adults: A systematic review. Ann Med Surg (Lond). 2024 Mar 12;86:2324-2330. PMID: 38487192.
* Liu K, Wang Z, Zhao P, Yan J, Peng Y, Song J. Acute appendicitis in the elderly: A retrospective cohort study. Medicine (Baltimore). 2017 Jul;96(27):e7381. PMID: 28684705.
* Al-Ghaithi B, O'Neill S, Coffey JC. Acute Appendicitis in the Elderly: A Retrospective Analysis. Cureus. 2023 Dec 16;15(12):e50588. PMID: 38222378.
Q.
What causes appendicitis?
A.
Appendicitis is typically caused by blockage of the appendix—most often from hardened stool (appendicolith), swelling of lymphoid tissue after an infection, or rarely a foreign body—leading to bacterial overgrowth, inflammation, and possible rupture. Risk factors include ages 10–30, male sex, low-fiber diets, family history, smoking, and recent gastrointestinal infections. There are several factors to consider; see the complete details below for symptoms to watch, how it’s diagnosed and treated, and when to seek urgent care.
References:
Bhangu A, Søreide K, Di Saverio S, Assarsson JH, & Drake FT. (2015). Acute appendicitis: modern understanding of pathogenesis, diagn… Lancet, 26063465.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis:… Journal of Hepatology, 16427119.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24698760.
Q.
Where is the appendix located?
A.
The appendix is a small, finger-like pouch attached to the cecum (the first part of the large intestine) in the right lower abdomen. Because its position can vary—often behind the cecum or hanging into the pelvis—the location of pain and the best tests or treatments can differ; there are several factors to consider, and important details that may guide your next steps are explained below.
References:
Singh K, & Sharma M. (2020). Anatomical variations of the vermiform appendix: a cadaveric… Anat Sci Int, 32106579.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in… J Hepatol, 16879800.
Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, & Lok ASF. (2003). A simple noninvasive index can predict both significant fibrosis… Hepatology, 12562982.
Q.
What illnesses could cause pain above the belly button when pressed?
A.
Pain above the belly button when pressed can be caused by various illnesses and conditions. Understanding these potential causes is important for proper diagnosis and treatment.
References:
Munisamy R, Uppalu H, Raghavendra R, Venkata NP, Harshita S, Janarthanam SV. Type-I complex regional pain syndrome of umbilical port site: An unforeseen complication of laparoscopic surgery. J Minim Access Surg. 2012 Apr;8(2):50-3. doi: 10.4103/0972-9941.95535. PMID: 22623826; PMCID: PMC3353613.
Patterson JW, Kashyap S, Dominique E. Acute Abdomen. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
https://www.ncbi.nlm.nih.gov/books/NBK459328/
Applegate WV. Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES): A Commonly Overlooked Cause of Abdominal Pain. Perm J. 2002 Summer;6(3):20–7. PMCID: PMC6220638.
Q.
What treatments are used for anisakiasis? Are procedures like endoscopy used?
A.
Anisakiasis is diagnosed and can be treated with endoscpoy to remove the parasite worms.
References:
Natasha S. Hochberg, Davidson H. Hamer, James M. Hughes, Mary E. Wilson, Anisakidosis: Perils of the Deep, Clinical Infectious Diseases, Volume 51, Issue 7, 1 October 2010, Pages 806–812
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Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015 Sep 26;386(10000):1278-1287. doi: 10.1016/S0140-6736(15)00275-5. Erratum in: Lancet. 2017 Oct 14;390(10104):1736. PMID: 26460662.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00275-5/fulltextSnyder MJ, Guthrie M, Cagle S. Acute Appendicitis: Efficient Diagnosis and Management. Am Fam Physician. 2018 Jul 1;98(1):25-33. PMID: 30215950.
https://www.aafp.org/pubs/afp/issues/2018/0701/p25.htmlWagner M, Tubre DJ, Asensio JA. Evolution and Current Trends in the Management of Acute Appendicitis. Surg Clin North Am. 2018 Oct;98(5):1005-1023. doi: 10.1016/j.suc.2018.05.006. Epub 2018 Jul 13. PMID: 30243444.
https://www.sciencedirect.com/science/article/abs/pii/S0039610918300707?via%3DihubMoris D, Paulson EK, Pappas TN. Diagnosis and Management of Acute Appendicitis in Adults: A Review. JAMA. 2021 Dec 14;326(22):2299-2311. doi: 10.1001/jama.2021.20502. PMID: 34905026.
https://jamanetwork.com/journals/jama/article-abstract/2787111