How to diagnose appendicitis

Written by Ren Zheng Xin
Gastroenterology
Updated on January 22, 2025
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Appendicitis is primarily diagnosed clinically through a physical examination. The patient is asked to lie flat, exposing the abdomen, with legs bent. The doctor stands on the patient’s right side and uses the right hand with fingers together to gently rub the abdomen, pressing on the McBurney's point. If there is significant pain, this is considered positive tenderness. Then, the doctor quickly lifts the fingers; if there is significant rebound pain, it is generally confirmed as acute appendicitis. During acute appendicitis, as the appendix lumen expands and the appendix becomes congested and edematous, ultrasound imaging can also show corresponding signs that serve as an auxiliary diagnosis. Once acute appendicitis is confirmed, it is mostly treated surgically.

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Written by Ai Bing Quan
General Surgery
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Can you exercise with appendicitis?

During the acute onset of appendicitis, it is not suitable to exercise. This is because the patient's immune system is weakened, and exercise can exacerbate the spread of inflammation, making the appendix more likely to perforate. In cases of chronic appendicitis, as well as during the recovery period after appendix surgery, moderate activities can be performed. Exercise can be carried out after the stitches are removed, but the intensity of the exercise should not be too high. It is necessary to progress gradually, and an abdominal binder should be used to protect the incision site. It's also important to strengthen nutrition, improve physical fitness, and eat more coarse grains to maintain smooth bowel movements.

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Written by Ren Zheng Xin
Gastroenterology
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Can appendicitis be contagious?

Appendicitis is a nonspecific inflammation occurring in the lumen of the appendix. It is not contagious, therefore, it is not an infectious disease. Once appendicitis is diagnosed, it is mostly treated surgically because the main blood supply to the appendix is the appendicular artery, which can easily lead to ischemic necrosis during inflammation. If controlled solely by medication, symptoms are likely to recur easily. Currently, appendectomy is commonly performed using minimally invasive techniques, under laparoscopy, which results in less bleeding during surgery and faster recovery afterward. Generally, if there is no suppuration or perforation, patients can be discharged three days after surgery. Postoperative care should be enhanced, including eating more vegetables to prevent constipation.

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Written by Li Jin Quan
General Surgery
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Where does chronic appendicitis hurt?

Chronic appendicitis, unlike acute appendicitis, does not begin with upper abdominal pain followed by pain in the lower right abdomen, which we refer to as migratory lower right abdominal pain; migratory lower right abdominal pain is a characteristic symptom of acute appendicitis. Chronic appendicitis typically presents with chronic recurrent pain, discomfort, dull pain, or bloating in the lower right abdomen. During a physical examination, chronic appendicitis generally manifests as fixed tenderness in the lower right abdomen, with less evident rebound pain. Rebound pain in the lower right abdomen during a physical exam only occurs when chronic appendicitis acutely flares up and signs of peritonitis are present.

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Written by Ren Zheng Xin
Gastroenterology
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Appendicitis McBurney's point location

McBurney's point is a point of tenderness on the body surface during an episode of appendicitis, located on the right side of the abdomen, specifically at the outer third of the line connecting the navel to the right anterior superior iliac spine. If the appendix is significantly swollen or suppurative, there will be intense tenderness and rebound pain at McBurney's point. The tenderness and rebound pain at McBurney's point are also important physical examination signs for the clinical diagnosis of appendicitis. Based on the tenderness at McBurney's point, a preliminary diagnosis of appendicitis can be made, and then, the state of appendiceal swelling can be examined by abdominal ultrasound to choose a systematic treatment based on the results.

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Written by Ren Zheng Xin
Gastroenterology
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Is appendicitis prone to recurrence?

Appendicitis, if treated by surgically removing the appendix, generally does not recur and can be cured. However, if one only uses medication to control the symptoms during an attack of appendicitis, it can easily recur. For appendicitis, laparoscopic appendectomy is currently the preferred surgical treatment. This method involves less bleeding during surgery and quicker recovery post-surgery. For elderly or frail patients who cannot tolerate general anesthesia, the traditional surgical method involving an incision at McBurney's point can be chosen. With this method, it is important to rest more. Patients can usually be discharged about a week after surgery. Postoperative care should be strengthened, dietary adjustments should be made, and more vegetables should be eaten to prevent constipation.