Any paramedic will be able to tell you that RLQ pain can indicate appendicitis, just as back pain radiating into the stomach and groin can indicate renal calculus, but what other assessments can be done to come to a differential diagnosis when presented with the acute abdomen and ?appendicitis case?
Firstly what is appendicitis? It's a blockage in the opening of the appendix that can result in infection. The 'vermiform appendix' is approx 11cm, is located off the caecum (the first portion of the large intestine) and, really, noone is entirely sure of it's usefulness.
When the appendix becomes blocked (most commonly from solidified faeces), it becomes inflamed and can fill with mucous and pus, generating an increase of pressure. The build-up of pressure compresses vessels leading to ischaemia, necrosis and infection. In the worst-case scenario the appendix can rupture, leaking all sorts of nasty bacteria (remember it's attached to your intestine!) throughout the peritoneal cavity, which can lead to peritonitis, abcesses, and potentially sepsis.
We can all agree that this is a bad thing.
So, aside from that RLQ abdominal pain, what else are we on the look out for when we suspect that the appendix is a course of pain?
Anorexia, nausea and vomiting are all common findings in the patient with appendicitis...however they are found in patients with many different types of abdominal pain!
Appendicitis pain can often start around the umbilical region as a generalised pain. This is because the appendix is innervated by T10 in the spinal cord, which innervates the dermatome around the umbilicus. As the pain progresses it becomes less generalised and more localised, down to the RLQ in the iliac fossa, "McBurney's Sign" (here's a video about identifying it here).
The pain can increase with coughing, exertion and movement.
The pain can increase on palpation, and is often worse on releasing the pressure when palpating (rebound tenderness).
Pain can increase on leg extension due to peritoneal irritation.
Patients can be febrile, but many present without fever.
So what can we do about it?
As cool as it would be to do a roadside appendectomy (ok, not really that cool...) there's not a lot of things we can do for the appendicitis patient that we don't do for any other patient with abdominal pain. In the worst-case, septic scenario, fluid resuscitation may be indicated, along with supplemental oxygen. For many patients, however, basic cares along with analgesia and antiemetics are going to be the best thing to offer this patient to ensure their comfort en route to hospital.
For more information and case-studies on appendicitis, check out the links below:
http://www.lifeunderthelights.com/2012/11/27/appendicitis-an-ems-case-review/#sthash.XhgXBV5w.dpbs
http://www.aafp.org/afp/1999/1101/p2027.html
http://www.scientificamerican.com/article/what-is-the-function-of-t/, http://www.webmd.com/digestive-disorders/news/20071012/appendix-may-have-purpose
http://www.mayoclinic.org/diseases-conditions/appendicitis/basics/causes/con-20023582