Diseases Simulating Appendicitis

Diseases Simulating Appendicitis Appendix is a tubular organ of narrow caliber; found attached to the first part of colon. Its structure is similar to that of intestine. Inflammation of it is termed as appendicitis. Its lumen may get obstructed to initiate infection. Infection can occur as such without an obstruction. The classical symptoms include

• Pain, starting from around the umbilicus and settling in the right lower abdomen.
• Vomiting, two to three times or till the stomach contents are expelled out.
• Fever, typically around 100 degree Fahrenheit.

The symptoms vary considerably to confuse with other diseases giving rise to similar symptoms.

• A Mackel's diverticulitis causes similar symptoms, but here pain is more toward the flanks and positions a little upwards. It is sometimes difficult to distinguish between the two; necessitating a surgical exploration.
• Diverticulosis or diverticulitis of right side of colon is often associated with that of left side, as diverticulum occur at multiple places throughout colon. Pain on pressure can be felt as well in the left side. It may be associated with blood and/or mucus in the stool. Usually, middle aged male suffer from it.
• Amoebic colitis of right side may give rise to similar symptoms, but usually associated with that of left side. Here, an identical pain on pressure spot on left side can be found. Besides this, a history of mucus motion in the recent past will help in diagnosis. A stool examination may be a corroborative finding.
• Right ureteric colic can be differentiated by the fact that, the patient is never comfortable in any one position and tries to change position frequently in search of relief from pain. Change of position hurts a patient suffering from appendicitis. A history of urinary tract infection and accompanying blood in urine may be helpful.
• Orchitis or epidydimo-orchitis of testis can be differentiated by the swollen and painful testis in that side. A history of filarial infection or mumps will aid the diagnosis.
• Mesenteric adenitis usually found in children can be differentiated by the shifting nature of pain with change of position of patient. A preceding history of upper respiratory infection will be supplementary to diagnosis.
• A perforated duodenum or stomach causes more problem in diagnosis. Here, there is card board like rigidity of abdomen, patient looks very sick, Symptoms and signs of shock may be present. Free gas under the diaphragm; seen in a plain x-ray, points towards perforation of hallow viscous.
• Inflammation of gall bladder; cholecystitis gives rise to Murphy's sign. It is, catching of breath while pressure is applied over the gall bladder in the height of respiration. Besides, a gall bladder may be palpable along with jaundice.
• Pancreatitis; inflammation of pancreas is a much more serious condition, usually associated with severe pain in the upper abdomen and features of shock. Here patient prefers to sit and lean forward to get relief from pain. History of gall bladder disease and alcoholism may be there.
• Salpingitis or parametratis of right side in ladies may confuse, but a history of discharge per vagina and a pelvic examination will exclude it.
• Ruptured ectopic tubal pregnancy can be differentiated by a history of stoppage of menstruation for two to three preceding months, profound anemia and features of shock.
• A twisted ovarian cyst simulates it; a per vaginal examination by an experienced gynaecologist always helps.
• Mid-cycle pain, Mittleschmerz is innocent condition which can be differentiated by history taking and observing the patient for some time.
• Endometriosis is a condition where sometimes bleeding occurs into the peritoneum from an ectopic inner layer of uterus. It is invariably associated with the timing of menstruation.

There can be a few more conditions and rare diseases which may come as differential diagnosis of appendicitis, which I have not mentioned here. An ultrasonogram by an experienced sinologist will invariably distinguish other disease and confirm appendicitis. A CT scanning may not be more informative than ultrasonogram. A plain x-rays is also helpful along with a simple urine analysis. Sometimes a diagnostic laparoscopy may help to diagnose the disease correctly, plan a surgery or a conservative approach. In spite of all these investigations, sometimes the correct diagnosis is not possible. An appendicectomy, if inadvertently performed causes no harm if no other disease if found. Lastly, the diagnosis of appendicitis is largely based on clinical finding; investigations increase the accuracy to a certain extent and more often supplement it. So, appendicitis is very easy as well as very difficult to diagnose even in these days.

Article Source: http://EzineArticles.com/?expert=Dr._Prahallad_Panda