Differential diagnosis of acute appendicitis

Food toxicoinfection. Complaints of pain in the epigastric region of the intermittent character, nausea, vomiting and liquid emptying are the first signs of disease. The state of patients progressively gets worse from the beginning. Next to that, it is succeeded to expose that a patient used meal of poorquality. However, here patients do not have phase passing, which is characteristic of acute appendicitis, and clear localization of pain. Defining the symptoms of irritation of peritoneum is not succeeded, the peristalsis of intestine is increased.

Acute pancreatitis. In anamnesis in patients with this pathology there is a gallstone disease, violation of diet and use of alcohol. Their condition from the beginning of a disease is heavy. Pain is considerably more intensive, than during appendicitis, and is concentrated in the upper half of abdomen. Vomiting is frequent and does not bring to the recovery of patients.

Acute cholecystitis. The high placing of vermiform appendix in the right half of abdomen during its inflammation can cause the clinic somewhat similar to acute cholecystitis. But unlike appendicitis, in patients with cholecystitis the pain is more intensive, has cramp-like character, is localized in right hypochondrium and irradiate in the right shoulder. Also the epigastric phase is absent. The attack of pain can arise after the reception of spicy food and, is accompanied by nausea and frequent vomiting by bile. In anamnesis patients often have information about a gallstone disease. During examination intensive painfulness in right hypochondrium, increased gallbladder and positive Murphy’s and Ortner’s signs are observed.

Perforated peptic ulcer. Diagnostic difficulties during this pathology arise up only on occasion. They can be in patients with the covered perforation, when portion of gastric juice flows out in an abdominal cavity and stays too long in the right iliac region, or in case of atypical perforations. On the abdominal X-ray gram under the right copula of diaphragm free gaze can be found.

The apoplexy of ovaryа more frequent is with young women and, as a rule, on the 10–14th day after menstruation. Pain appears suddenly and irradiate in the thigh and perineum. At the beginning of disease there can be a collapse. However, the general condition of patients suffers insignificantly. When not enough blood was passed in the abdominal cavity, all signs of pathology of abdominal cavity organs calm down after some time. Signs, which are characteristic of acute anemia, appear at considerable haemorrhage. Abdomen more frequent is soft and painful down (positive Kulenkampff’s sign: acute pain during palpation of stomach and absent tension of muscles of the front abdominal wall).

Extrauterine pregnancy. A necessity to differentiate acute appendicitis with the interrupted extrauterine pregnancy arises, when during the examination the patient complains of the pain only down in the stomach, more to the right. Taking it into account, it is needed to remember, that at extrauterine pregnancy a few days before there can be intermittent pain in the lower part of the abdomen, sometimes excretions of “coffee” colour appear from vagina. In anamnesis often there are the present gynecological diseases, abortions and pathological passing of pregnancy. For the clinical picture of such patient inherent sudden appearance of intensive pain in lower part of the abdomen. Often there is a brief loss of consciousness. During palpation considerable painfulness is localized lower, than at appendicitis, the abdomen is soft, the positive Kulenkampff’s sign is determined. Violations of menstrual cycle testify for pregnancy, characteristic changes are in milk glands, vagina and uterus. During the vaginal examination it is sometimes possible to palpate increased tube of uterus. The temperature of body more frequently is normal. If haemorrhage is small, the changes in the blood test are not present. The convincing proof of the broken extrauterine pregnancy is the dark colour of blood, taken at puncture of back fornix of vagina.

Right-side kidney colic. For this disease pain at the level of kidney and in lumbus is inherent, haematuria and dysuria signs can take place at the irritation of ureter by the inflamed appendix. Intensity of pain in kidney colic is one of the basic differences from acute appendicitis. Pain at first appears in lumbus and irradiate downward after passing of ureter in genital organs and front surface of the thigh. In diagnostics urogram survey is important, and if necessary – chromocystoscopy. Absence of right kidney function to some extent allows eliminating the diagnosis of acute appendicitis.

Diabetic abdomen indicates abdominal pain and vomiting which precede coma.