ZocdocAnswersCan you have appendicitis with only moderate to mild RLQ pain?

Question

Can you have appendicitis with only moderate to mild RLQ pain?

I've been ill for 12 days now. My RLQ is steadily mild I'd rate it at a 2, however when I start to feel very ill (fever 99.5, extreme nausea, shaky, pale, and weak) my pain increases to about a 6. I went to an urgent care llast Thursday and they referred me to the ER. my WBC wasn't elevated (I hadn't had any fever yet, that came on a few days later) so the ER said no way it was my appendix and sent me saying it was a stomach bug. I have an appointment with my pcp Wednesday but I feel like I'm getting worse. I don't want another ER bill if I can wait until Wednesday and just see my pcp. What do you think?

Answer

Anytime you think you might have something as serious as acute appendicitis, you should either be seen that day at your doctor's office or you should proceed to the nearest emergency department. Acute appendicitis is a condition that is sometimes difficult to diagnose. The symptoms typically start with a generalized feeling of unwellness, subtle abdominal pain near the belly button, loss of appetite, and fever. The pain then often moves from the belly button area to the right lower quadrant of the abdomen. The abdomen is often tender to the touch as well. Your pain is mild, but this does not really matter because everyone has different tolerances to pain. The lack of a WBC elevation does speak against the diagnosis. You don't have a fever (need temp of 100.4). If you have a normal appetite, then I probably would not consider this acute appendicitis. However, I would reserve that decision until after I examined your abdomen. Again, anytime you think you might have something as serious as acute appendicitis, you should either be seen that day at your doctor's office or you should proceed to the nearest emergency department. This is because a ruptured appendix (the feared complication of acute appendicitis) can result in death. Diagnosis of acute appendicitis is made by the physical exam and history, and sometimes with the help of a contrast enhanced CT scan of the abdomen and pelvis. If there is enough suspicion that acute appendicitis is present, then a surgeon will take you the operating room to have it removed.

This answer is for general informational purposes only and is not a substitute for professional medical advice.

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