Appendicitis Tests: Physical Exams, Lab Tests for Diagnosis & Treatment

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Appendicitis Tests
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Appendicitis occurs when your appendix becomes inflamed due to a blockage in the hollow portion of the organ, which could be caused by anything from calcified feces and gallstones to parasites and tumors.

Appendicitis tests such as physical tests, blood tests, urine tests, and imaging tests are used to confirm an appendicitis diagnosis.

Once the appendicitis tests confirm the condition, appendicitis medical treatment options can then be assessed, selected, and begun, hopefully before any major internal damage has begun.

Appendicitis Tests and Diagnosis

Appendicitis can be a bit of a concerning issue. If it isn’t caught in time, the appendix can burst and spill its infectious contents into the abdominal cavity. Furthermore, a burst appendix can cause peritonitis, which is an inflammation of abdominal cavity’s lining that causes death if not treated quickly and properly.

There are a few appendicitis tests that are used to detect the condition. These include looking at the patient’s medical history, physical examinations, and lab and imaging tests.

1. Appendicitis Medical History

The first signs that you may have appendicitis are physical symptoms, mainly abdominal pain. The doctor will ask you questions like when did the pain start, how badly does it hurt, and where is it located.

You will also be asked about other medical conditions, previous illnesses and surgical procedures, and whether you use medication, alcohol, or illegal drugs. All this helps to rule out any other possible causes of the abdominal pain.

2. Appendicitis Physical Exam

After a brief discussion with the doctor, he or she will perform an appendicitis physical exam. Two main appendicitis tests are usually performed—a rebound test and a psoas test.

Rebound Test

The rebound test for appendicitis is quite simple. The doctor will lay hands on the area of the abdomen around the appendix.

Using their hands, the doctor will push on the area to creating pressure, and then quickly remove their hands (this can also be done using a few fingers). The quick release of the pressure should spike the pain levels in the patient if appendicitis is present.

Psoas Test

The psoas test or Cope’s psoas test is used to find irritation in the iliopsoas group of hip flexor muscles. This irritation is usually connected to inflammation of the appendix as these muscles are in very close proximity to the organ. This is especially the case with the right iliopsoas, as it lays under the appendix when you are on your back.

The doctor will flex your leg at the hip and knee, and then internally rotate the hip. This will cause a spike in pain if appendicitis is present.

While the rebound test and psoas test are the two most common tests, there are a few other physical exams that the doctor can use as well. For example, it’s not uncommon to have a pelvic exam or a digital rectal exam.

During these physical appendicitis tests, the doctor will also look for a few physical symptoms such as guarding. This occurs when an organ is inflamed and infected, causing the abdomen muscles to tense up to protect the organs. Guarding can be detected via a simple laying of hands or during one of the other physical abdominal exams.

Rovsing’s sign is a test where pressure on the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant. When rebound or psoas tests are done, the doctor will most likely also perform Rovsing’s sign.

3. Lab Tests for Appendicitis

Lab tests are often used to confirm an appendicitis diagnosis after a physical examination has been done.

Blood Tests

Blood tests are often done to look for an elevated number of white blood cells, which is a sign that the body is fighting an infection.

Urinalysis

A urinalysis may be performed to rule out other medical conditions that can result in similar abdominal pains like kidney stones and urinary tract issues.

Pregnancy Test

In women, pregnancy tests are often ordered as some symptoms of pregnancy, like abdomen tenderness, can be similar to the symptoms of appendicitis.

4. Imaging Tests

Imaging tests can be used to not only confirm appendicitis but also to get a better look at the condition of the appendix. The tests most often used in these cases are ultrasounds, magnetic resonance imaging tests (MRIs), laparoscopies, and computerized tomography (CT) scans.

An ultrasound of the abdominal area may be able to reveal the extent of the inflammation in the appendix by using sound waves while an MRI is similar but uses radio waves. And a CT scan uses x-rays to take a deeper look at the appendix.

A laparoscopy is a surgical procedure where a small tube camera is inserted into the body via a small incision. This test can give doctors a direct image of what the appendix looks like and what kind of damage is visible.

Barium enemas are not as common as the other tests, but they can be used to visualize the appendix via x-rays. Liquid barium is inserted into the colon via the anus to help reveal how the infection of is affecting the colon. Barium enemas can also be used to rule out other causes like Crohn’s disease.

These appendicitis tests can reveal any inflammation of the appendix as well as the size, any blockages, and even a burst appendix. Once the extent of inflammation and possible damage are revealed to medical professionals, treatment options can then be discussed and carried out.


Appendicitis Complications

Appendicitis complications arise mainly from a perforated or burst appendix. As a result, the infected material leaves the appendix, causing issues in the abdominal cavity. It can infect other organs, most notably the peritonitis, which is the lining of the abdominal cavity.

The infected material may also cause abscesses in the abdominal cavity that can become filled with pus and other infected substances. These are called appendiceal abscesses, and they will also need to be taken care of along with the infected appendix.

How to Cure Appendicitis (Appendicitis Treatment)

If the tests mentioned above conclude that you are suffering from appendicitis, there may be a few options given, but they may depend on how severe the appendicitis is.

Antibiotics

In the case of a mild inflammation and infection, the doctor may choose antibiotics as a treatment. A course of antibiotics may help repair the damage the infection has caused to the appendix.

Surgery

More often than not, if an appendix is heavily inflamed and infected, surgery is usually the primary option. The surgeon will remove the appendix before it bursts to prevent further issues with the organ. This can be done via laparoscopic surgery, where the appendix is removed using numerous small cuts in the abdomen as opposed to one big cut.

The other method is laparotomy, which is where the appendix is removed via one large incision rather than many small ones. Laparotomy is the method most often used when the appendix is close to bursting or if it has already burst. This surgical method allows a surgeon more room to work using tools that are required to clean out the infection, as well as to drain out any appendiceal abscesses that may have formed due to the infection.

Draining Abscesses

One of the complications that can occur with appendicitis is the formation of appendiceal abscesses. These abscesses form when the appendix has become perforated or has burst, letting the infected material that it contained to find a new home in the abdominal cavity. If these have formed, they must be drained.

Abscesses are drained using a suction tube inserted into the affected area through an incision. This is usually done as part of a laparotomy, as the tools used during this procedure have a drainage attachment.

Recovery

Recovery is fairly quick as there may be little in further treatments after the appendix has been removed.

Physical activity will be limited while the incisions heal. The timeline may depend on how fast you heal and the type of surgery you had.

Laparoscopic surgery usually carries with it a three- to five-day limitation of physical activity while a laparotomy usually comes with 10 to 14 days of restrictions. And antibiotics are often recommended after surgery to prevent any post-surgery infections.

Appendicitis Not a Big Deal If Caught Early and Treated

Having your appendix out is not particularly a big deal these days. With the way modern medicine is, it can be caught and quickly treated within a few hours. When the condition is diagnosed using various appendicitis tests, it can make a difference between the types of surgery you must have, how long the surgeon has to work, and how much infection needs to be treated within your body.

Not getting appendicitis treated quickly can mean more time in surgery. And if it’s not caught at all, it could mean serious infection and possibly death. So, it’s important to heed the symptoms that your body produces and speak to you doctor if you are suffering from abdominal pain that doesn’t seem to go away after a day or two.

Related Articles: 

How to Prevent Appendicitis: Foods and Lifestyle Changes


Sources
“Appendicitis,” MedlinePlus; https://medlineplus.gov/appendicitis.html, last accessed September 5, 2017.
“Appendicitis,” National Institute of Diabetes and Digestive and Kidney Diseases; https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis, last accessed September 5, 2017.
“Appendicitis,” Mayo Clinic, August 20, 2014; http://www.mayo.edu/diseases-conditions/appendicitis/basics/tests-diagnosis/con-20023582, last accessed September 5, 2017.
Carteron, N., “Everything You Need to Know About Appendicitis,” Healthline, March 8, 2017; http://www.healthline.com/health/appendicitis#overview1, last accessed September 5, 2017.
“Appendicitis – Diagnosis,” NHS Choices, January 3, 2016; http://www.nhs.uk/Conditions/Appendicitis/Pages/Diagnosis.aspx, last accessed September 5, 2017.

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