My daughter is 14 and has permanent pain in the lower abdomen to the right, often associated of nausea, rarely with fever. She does not have any suspicious discharge though. Once a nurse examined her and suggested that it is hard to establish whether it's her appendix or the ovary involved. She advised to get an MRI exam which I can't afford. Please help me understand how can I distinguish between.
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Oophoritis rarely occurs on both sides at the same time; generally on one side - most frequently on the left. Roughly in 32 % of cases, right ovaritis (oophoritis dextra ) is combined with appendicitis (cross-inflictive). If your primary inquiry is about the clinical signs and tips for physical exam which would help you differentiate in home-testing, here are some basics.
(1) SURGICAL ANATOMY: Salpinx (tubes and ovary) and the uterus have extraperitoneal location (behind the peritoneum). Caecum and ascending colon too, are covered retroperitoneally by the posterior peritoneum. The position of appendix can vary considerably, both in relation to the caecum and because of the inconsistent position of the caecum itself. In nearly 30% there is a wandering vermiform appendix that may reach the right salpingx.
(2) CAUSE: Ovarian inflamation is usually caused by gonorrhea, genital tuberculosis, chlamydia, and mumps (parotidis). Appendicits is caused by unhealthy diet (lack of fiber, lack of lactobacillus, processed low-quality food that causes chronic constipation) and number of infection agents: bacteria (shigella, yersinia pestis), cytomegalovirus, adenovirus, fungi, parasits (schistosomiasis, ascarid, strongyloides stercoralis).
(3) PAIN TOPOLOGY: In a normal position of the appendix, the pain of appendicitis is situated at a point between the navel and the front edge of the right hipbone. In many, however, the appendix is lying in an abnormal position. This may manifest a pain in a different, misleading location. In oophorities, the pain is located in the lower back on the inflamed side, it sometimes extends to the adjoining parts, to the thigh of the affected side, which feels numb and rigid; it is aggravated by the patient suddenly raising herself. The ovarian pain is dull, less intense, sometimes rather burning, but more frequently stinging pain in the groin.
(4) PAIN "READING": Chronic oophoritis is easily confounded with hysteria. There is a bearing-down sensation in the pubic region and perineum; at times menstrual irregularities and leucorrhea (unspecific white discharge). The pain sometimes extends to the adjoining parts, even to the thigh of the affected side, which feels numb and rigid; it is aggravated by the patient suddenly raising herself, and by straining at stool. If your daugter is examined on her back - with the limbs drawn up, a deep-seated swelling of variable size is felt through the abdominal wall, directly over the horizontal ramus of the pubes, on one side of the median line of the abdomen.
To differentiate the lower back pain of oohpritis from the possible renal infection (pyelonephritis), you may try the Murphy sign: if a percussion of the kidney of the affected side intensifies the pain, it is not oophoritis (it may be pyelitis or pyelonephritis).
If the pain is located in the inguinal area or the lower abdomen, a gentle pressure on the painful area will intensify the pain if it is sole appendicitis. In appendicitis, there is an abdominal rebound rigidity, a tendency to stiffen the abdominal muscles in response to the pressure over the inflamed appendix (the body's defense strategy, guarding). Ergo, if you ask your daughter to lay down and turn to the left side, the pain will intensify because the inflamed appendix will pull the adjusent peritoneum to the left. This sign is absent during the oophoritis.
(5) PHRENICUS NERVE SYNDROME: The phrenic nerve originates mainly from the 4th cervical nerve, but also receives contributions from the 5th and 3rd cervical nerves (C3-C5). Thus, the phrenic nerve receives innervation from both cervical and brachial plexi. As such, inflammation of gastrointestine organs neighboring the diaphragm, may cause pain in the right shoulder. Understandably, n.phrenicus syndrome is absent in oophoritis and may be present in wandering and inflamed appendix.
(5) DRY MOUTH, NAUSEA, PAIN BEFORE VOMITING, REBOUND TENDERNESS: Those are typical signs of appendicitis, not oophoritis.
(6) WHAT TO EXPECT FROM THE EXAMINING PHYSICIAN:
(a) If you daughter is virgin, the doctor will perform rectal exam to palpate the inflamed area.
(b) WBC: In appendicitis, leukocytes (white blood cells) are increased to 12,000–20,000. In opphoritis too, this count is higher with the same > 75 % shift to the left (neutrophils), but the WBC does not exceed 10,000-12,000.
(c) Pelvic ultrasound
(d) Pelvic x-ray
(e) CT scan
(f) Point-of-care guide
Good luck.
(1) SURGICAL ANATOMY: Salpinx (tubes and ovary) and the uterus have extraperitoneal location (behind the peritoneum). Caecum and ascending colon too, are covered retroperitoneally by the posterior peritoneum. The position of appendix can vary considerably, both in relation to the caecum and because of the inconsistent position of the caecum itself. In nearly 30% there is a wandering vermiform appendix that may reach the right salpingx.
(2) CAUSE: Ovarian inflamation is usually caused by gonorrhea, genital tuberculosis, chlamydia, and mumps (parotidis). Appendicits is caused by unhealthy diet (lack of fiber, lack of lactobacillus, processed low-quality food that causes chronic constipation) and number of infection agents: bacteria (shigella, yersinia pestis), cytomegalovirus, adenovirus, fungi, parasits (schistosomiasis, ascarid, strongyloides stercoralis).
(3) PAIN TOPOLOGY: In a normal position of the appendix, the pain of appendicitis is situated at a point between the navel and the front edge of the right hipbone. In many, however, the appendix is lying in an abnormal position. This may manifest a pain in a different, misleading location. In oophorities, the pain is located in the lower back on the inflamed side, it sometimes extends to the adjoining parts, to the thigh of the affected side, which feels numb and rigid; it is aggravated by the patient suddenly raising herself. The ovarian pain is dull, less intense, sometimes rather burning, but more frequently stinging pain in the groin.
(4) PAIN "READING": Chronic oophoritis is easily confounded with hysteria. There is a bearing-down sensation in the pubic region and perineum; at times menstrual irregularities and leucorrhea (unspecific white discharge). The pain sometimes extends to the adjoining parts, even to the thigh of the affected side, which feels numb and rigid; it is aggravated by the patient suddenly raising herself, and by straining at stool. If your daugter is examined on her back - with the limbs drawn up, a deep-seated swelling of variable size is felt through the abdominal wall, directly over the horizontal ramus of the pubes, on one side of the median line of the abdomen.
To differentiate the lower back pain of oohpritis from the possible renal infection (pyelonephritis), you may try the Murphy sign: if a percussion of the kidney of the affected side intensifies the pain, it is not oophoritis (it may be pyelitis or pyelonephritis).
If the pain is located in the inguinal area or the lower abdomen, a gentle pressure on the painful area will intensify the pain if it is sole appendicitis. In appendicitis, there is an abdominal rebound rigidity, a tendency to stiffen the abdominal muscles in response to the pressure over the inflamed appendix (the body's defense strategy, guarding). Ergo, if you ask your daughter to lay down and turn to the left side, the pain will intensify because the inflamed appendix will pull the adjusent peritoneum to the left. This sign is absent during the oophoritis.
(5) PHRENICUS NERVE SYNDROME: The phrenic nerve originates mainly from the 4th cervical nerve, but also receives contributions from the 5th and 3rd cervical nerves (C3-C5). Thus, the phrenic nerve receives innervation from both cervical and brachial plexi. As such, inflammation of gastrointestine organs neighboring the diaphragm, may cause pain in the right shoulder. Understandably, n.phrenicus syndrome is absent in oophoritis and may be present in wandering and inflamed appendix.
(5) DRY MOUTH, NAUSEA, PAIN BEFORE VOMITING, REBOUND TENDERNESS: Those are typical signs of appendicitis, not oophoritis.
(6) WHAT TO EXPECT FROM THE EXAMINING PHYSICIAN:
(a) If you daughter is virgin, the doctor will perform rectal exam to palpate the inflamed area.
(b) WBC: In appendicitis, leukocytes (white blood cells) are increased to 12,000–20,000. In opphoritis too, this count is higher with the same > 75 % shift to the left (neutrophils), but the WBC does not exceed 10,000-12,000.
(c) Pelvic ultrasound
(d) Pelvic x-ray
(e) CT scan
(f) Point-of-care guide
Good luck.
I'm sorry to hear about your daughter's pain. You are correct, several things can cause right sided pain including the ovary or appendix. An MRI is not ideal to look at this structures. A better test that is also much less expensive to help clarify if this is due to an ovarian cyst, twisting of the ovary, or an enlarged appendix is a Pelvic ultrasound in addition to some basic lab work to rule out infection. Vaginal discharge would not be present in either of those conditions that I mentioned unless she is sexually active which would warrant an evaluation by an ob/gyn instead of her pediatrician. Hope she feels better soon.
If your daughter is not sexually active it is unlikely she has Oophoritis, however she may have an ovarian cyst. A complete blood count and sedimentation rate would help determine whether there is an infectious process , and the most useful test would be a pelvic ultrasound with an attempt to locate the appendix. Appendicitis is general accompanied by a loss of appetite and fever, and is a progressively worsening condition. Ovarian cysts almost always resolve on their own. Bring her to the pediatrician.
It's very easily distinguished.
Best to see a qualified Gyn.
Best to see a qualified Gyn.
You may not be able to distinguish, but ovarian pain is usually associated with the menstrual cycle. Oophoritis is associated with sexual contact, so make sure your daughter isn't sexually active at this time. The appendix gets inflamed if we don't eat enough fiber or take probiotics. Take one culturelle capsule daily. Don't by some off brand thinking it's cheaper. Make sure your daughter eats plenty of fruits and vegetables, for fiber, and this also helps the hormones. Make sure she is not drinking any soda or sugared beverages, and is drinking 7 cups of water daily. If she gets severe pain or a fever go to urgent care. Here is the best way I find to balance hormones. Do this for 6+ months and you will see PMS, acne, cramps, and other abnormal hormone symptoms improve: 'Want a quick and easy way to start balancing your hormones? Whether it's PMS or cramps or plain grumpiness, this simple addition to your day has been shown to help all of these! From day one of your period (the first day you bleed), take 2 TBSP of GROUND flax/chia/pumpkin seeds. Choose any seed you like, but be sure to grind them first. Flax seeds are conveniently sold ground already. Then, 2 weeks later (15 days from start of bleeding), switch to ground sunflower or sesame seeds. If your period is very irregular, you can use the moon cycle: day 1 of the month is the new moon. Then, on the full moon switch to sunflower/sesame seeds. The flax/chia/pumpkin seeds contain oils and compounds that support estrogen, and the other seeds support progesterone, right when we need it. Because this is very powerful, do not use this if you are using any kind of hormonal contraception. Do not use if you are allergic to any of these seeds.'
FLAX IS FIRST; SESAME IS SECOND!
Day 1 of menses through day 14: take 2 caps of Organic Flax oil twice daily
Day 15 of menses until day 1 (bleeding): take 2 caps of GLA 130 (primrose oil) twice daily
FLAX IS FIRST; SESAME IS SECOND!
Day 1 of menses through day 14: take 2 caps of Organic Flax oil twice daily
Day 15 of menses until day 1 (bleeding): take 2 caps of GLA 130 (primrose oil) twice daily