Diagnosis
When looking for the cause of right-sided abdominal pain, the period since when the symptoms have been present is particularly important. For example, symptoms that have been present for weeks or even months do not indicate an acute event, while pain that has been present for days or several hours and is getting steadily worse is more likely to indicate an acute inflammatory process. When observing the patient, the abdomen should be examined more closely and it should be checked whether the area is distended and over-inflated or is in an inconspicuous state.
During the physical examination, the abdomen must first be listened to with a stethoscope and the intestinal sounds characterised. Loud, metallic-sounding intestinal noises (so-called elevated intestinal noises) are more likely to indicate an intestinal obstruction. Inflammatory processes in the bowel usually do not become noticeable by changes in bowel sounds.
After examining the bowel sounds with a stethoscope, the abdomen should be palpated and the abdominal consistency examined. It is important to pay attention to whether the abdomen is soft, which is more likely to indicate a more harmless course of the disease, or hard as a board, which could indicate an emergency situation. The sensitivity of the abdomen to pain should also be checked.
If the patient only complains of slight pain during deep palpation, it is probably only a mild disease. In the case of an acute inflammation, deep palpation of the abdomen is often not permitted by the patient because of pain. Characteristic for the inflammation of the appendix is the pain on the right side when palpating the left side and the limited ability of the patient to stand up or lift the right leg.
In the case of appendicitis, jumping or coughing is also accompanied by sometimes massive pain or is not possible at all. In addition to the physical examination, general symptoms such as fever should be checked and the patient should be asked when his last bowel movement was. Furthermore, an examination of the blood should be carried out to see if there are any inflammatory reactions in the body.
An ultrasound examination can also be used. Here the gall bladder can be examined for gallstones or the ureter for urinary stones. In some cases, the appendix can be examined for possible wall thickening with ultrasound.
The treatment depends on the type of disease. An appendicitis is usually treated surgically. The appendix is removed either laparoscopically or openly under general anesthesia.
In the case of diverticulitis, it is usually waited to see whether it is a chronic form of the disease (in which case antibiotic treatment is more appropriate) or an acute form (surgical removal of the appendix). An intestinal obstruction must be treated surgically in almost all cases, depending on the cause. If ureteral stones or gallbladder stones are responsible for the right-sided abdominal pain, they can either be salvaged by a small catheter (ureteral stones) or treated surgically. In the case of gallbladder stones, the entire gallbladder is usually removed surgically. Even in the case of a gall bladder inflammation, the entire gall bladder is usually removed laparoscopically.