• Abdominal pain
  • Pain may begin in the upper-middle abdomen (epigastric), then develop to sharp localized pain
  • Pain may shift from the epigastric area to become most intense in the lower right side of the abdomen ("typical" case), tenderness of this area is common
  • Pain initially may be vague, but becomes increasingly more severe
• Point tenderness, especially over the right lower quadrant of the abdomen
• Nausea and vomiting
• Fever usually occurs within several hours

Abdominal pain may be worse when walking or coughing. The patient may prefer to lie still; sudden jarring motions or bumping can cause pain.

Later symptoms:

• Fever
• Loss of appetite
• Nausea
• Vomiting
• Constipation
• Rectal tenderness
• Chills and shaking

Additional symptoms that may be associated with this disease include bloody urine (microscopic hematuria).

With appendicitis, pain increases when the abdomen is gently pressed and then the pressure is suddenly released. Touching the abdomen may cause a spasm of the abdominal muscles if peritonitis is present. Rectal examination may also cause pain, localized on the right side.

The health care provider may perform other tests, including having the patient lie on his or her back with the following:

• The right leg is extended straight up.
• The knee and hip are flexed, and then the leg is rotated inward and outward.
• The lower left portion of the abdomen is palpated.

Each of these actions will cause pain in the lower right quadrant of the abdomen of a person with appendicitis.

Appendicitis may be strongly suspected based on the following tests:

• CBC, often shows an increased white blood cell count
• Abdominal sonography
• Abdominal CT scan

The surgeon may confirm the diagnosis during an exploratory laparotomy. The operation may be done as an open procedure or through a laparoscopic approach that uses a small camera and requires a smaller incision.

It is important to realize that not all surgical explorations for appendicitis reveal an abnormal appendix. Approximately 10-15% of operations for suspected appendicitis reveal either no obvious abnormality, or a disease process other than appendicitis. This relatively high rate of "negative appendectomies" is tolerated because the consequences of not diagnosing appendicitis in patients with abdominal pain can be severe and sometimes life-threatening.

If an operation for suspected appendicitis reveals a normal appendix, the surgeon will probably remove the appendix anyway, and then explore the rest of the abdomen for other possible causes of pain. In some cases, this may require extension of the surgical incision.