Physical exams and medical records
To perform a complete analysis of a case, the doctor will interview the patient on the history of the symptoms. He will gather all the necessary information – which will obviously remain confidential unless the patient decides otherwise – on when the pain started, what was its location, how did it manifest, what is the possible nature of the pain, whether it had different patterns. External causes, from possible genetic inheritance, previous surgical interventions or diseases, medication or allergic factors, to legal (alcohol, tobacco) or illegal drugs must also be taken into consideration.
The next step is a general examination from head to toe starting with a check on the vital signs because other diseases can produce pain in the abdominal area as it happens with pneumonia or heart problems. There are many symptoms that may be common to several conditions. This incertitude demands more accuracy and makes necessary the examining of body temperature, breathing and pulse rate and blood pressure. Not any swelling of lymphatic nodes or fever demand surgical intervention.
The actual abdominal exam will establish whether it is appendicitis or not. It is important to know where the pain is located and how the body reacts to it. The reply of pain is an increased sensitivity to touch. The peritoneal signs represented by rebound tenderness and guarding are factors of decision regarding the necessity of surgery. The first one consists in greater sensitivity of the area, in case or pressure release than in the moment of actual pressure, while the second one consists in muscle involuntary contraction, when the doctor pressures the area. The physician will further follow Rovsing’s sign (when exerting pressure on the left side the pain is felt on the right side), psoas sign (abdominal pain related to the flexion of the hip) or obturator sign (pain on internal rotation of the hip). Unfortunately not all patients respond to these examinations so it is impossible to know for sure.
Tests performed in the laboratory
Signs of infection, as high number of leucocytes, can only be determined by blood tests. The chemistry of blood may possibly indicate disorders on fluids and electrolytes or dehydration. The analysis of urine will exclude the possibility of urinary tract infection. In some cases pregnancy tests are ordered by the doctor for women.
By means of ultrasounds, X -rays and computed tomography scans (CT), the doctor gets an abdominal image. Signs of perforation, obstruction, foreign bodies or even appendicolith will certainly be shown by plain X- rays (not recommended for pregnant women), while the ultrasound will determine either appendiceal inflammation or gall bladder disease and pregnancy. The most accessible test is CT scan which gives a series of cross – sectional images of the body and discovers possible abdominal affections.
In women the symptoms of appendicitis may also come from inflammation of the ovary or of the fallopian tube so their nature will be determined by laparoscopy, a procedure that excludes radiation but is still complicated because general anaesthesia is necessary. It is a method that implies the insertion inside the body of a small camera attached to a thin tube which can provide images of the internal organs, and also perform surgery in particular cases.