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Acute abdominal pain: appendicitis or not

The abdomen is the one place where a painkiller can cost a life: it masks the picture, and the surgeon sees a "quiet" abdomen when peritonitis has already begun. The rule is simple — severe pain lasting more than two hours, especially with fever and vomiting, needs an examination, not a tablet.

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What to do right now

No painkillers
No analgesics or antispasmodics before assessment. The only exception is an antispasmodic for a known renal colic.
No food or drink
If surgery follows, the stomach must be empty. Moistening the lips is fine.
Cold, not heat
A heating pad accelerates peritonitis. An ice pack through a towel on the painful area is acceptable.
Remember how it behaved
Where it started, where it moved, whether it relates to food, stool or urination. Appendicitis often starts near the navel and moves to the lower right within hours.
Find the position
Lying on the side with the knees drawn up feels better — in itself a sign of peritoneal irritation.

Call an ambulance if

Severe pain lasting more than 2 hours or increasing
Pain with fever, vomiting or bloating
A board-like abdomen, painful even to light touch
Pain in the lower right that worsens on coughing and walking
Vomiting blood or bile, black stools, no stool or gas for more than a day
Lower abdominal pain in a woman with a missed period or in early pregnancy
Abdominal pain in a child who will not let you touch the abdomen, or in an elderly person with a muted reaction

What not to do

Do not give painkillers or antispasmodics before assessment
Do not apply heat to the abdomen
Do not give an enema or a laxative
Do not wait until morning if the pain is getting worse at night — appendicitis does not sleep

What the crew does

Abdominal examination, temperature, blood pressure, assessment of peritoneal signs
Rapid tests and an ECG in the elderly — a heart attack can masquerade as abdominal pain
Decision: observation at home or admission to surgery
Transport to a surgical hospital by dispatch order; in Moscow dozens of city hospitals are on duty, children go to Morozovskaya, St Vladimir and Filatovskaya

This page is for information and does not replace a medical examination. If the condition worsens, call the crew: +7 (985) 887-82-52.

This page in Russian: Russian version.

Questions

How do I tell appendicitis from poisoning?

Poisoning starts with vomiting and diarrhoea, the pain is diffuse and crampy with relief between spasms. Appendicitis gives constant, growing pain that shifts to the lower right, a temperature of 37.5–38 °C and one or two episodes of vomiting. Only an examination is conclusive.

How much does a call-out for abdominal pain cost in Moscow?

Call-out 6,000 ₽ inside the MKAD; transport 6,000 ₽ per 30 minutes if admission follows. Hospital treatment under insurance is free.

How long can appendicitis wait?

It cannot. Peritonitis usually develops within 24–48 hours; the best results come from surgery in the first 12 hours.