VHOSPITAL.CLINIC · Differential Diagnosis
Appendicitis vs Cholecystitis
Clinical comparison — shared symptoms, key differences, distinguishing diagnostic tests, treatment pathways, and when to seek urgent evaluation.
Condition Overview
Condition A
Appendicitis
Appendicitis is inflammation of the appendix causing progressive right lower quadrant abdominal pain, nausea, fever, and rebound tenderness. Perforation risk increases with delayed treatment; surgical removal (appendectomy) is standard care.
Condition B
Cholecystitis
Cholecystitis is inflammation of the gallbladder, usually caused by gallstones blocking the bile duct. It causes severe pain in the upper right abdomen, nausea, vomiting, and fever. Acute cholecystitis often requires surgery.
Shared Symptoms — Why They're Confused
Both conditions present with 4 overlapping symptoms, making clinical differentiation essential.
Key Clinical Differences
Appendicitis
- Periumbilical pain migrating to RLQ (McBurney's point)
- Nausea, vomiting, anorexia
- Rebound tenderness; Rovsing's sign
- Elevated WBC with neutrophilia
Cholecystitis
- RUQ pain radiating to right shoulder (Murphy's sign)
- Onset after fatty meal
- Fever and rigors in complicated cholecystitis
- Elevated ALP, GGT; ultrasound shows gallstones + wall thickening
Distinguishing Diagnostic Tests
| Test | Appendicitis | Cholecystitis |
|---|---|---|
| Location of tenderness | Maximal at McBurney's point (RLQ) | Maximal at RUQ; Murphy's sign positive (pain on palpation during inspiration) |
| Ultrasound abdomen | Enlarged non-compressible appendix >6 mm; periappendicular fluid | Gallstones, gallbladder wall thickening >3 mm, pericholecystic fluid |
| CT abdomen | Appendix >6 mm with periappendiceal fat stranding — gold standard | Gallbladder distension with wall enhancement; may show perforation |
Treatment Approaches
Appendicitis
- •Emergency appendicectomy (laparoscopic)
- •Antibiotics pre-op; conservative in uncomplicated cases
Cholecystitis
- •Analgesia, IV fluids, antibiotics (cephalosporin + metronidazole)
- •Laparoscopic cholecystectomy (elective or urgent)
When Doctors Consider Each Diagnosis
🔵 Consider Appendicitis when:
- →RLQ tenderness, McBurney's point, Rovsing's sign, migratory pain
🟢 Consider Cholecystitis when:
- →RUQ tenderness, Murphy's sign, post-fatty meal, gallstones on USS
Explore Each Condition in Detail
Related Clinical Pages
Appendicitis
Medical References
Content on this page is informed by evidence-based clinical sources including:
- World Health Organization (WHO)Global health guidance and disease classification
- National Health Service (NHS)UK clinical guidelines and patient information
- National Institute for Health and Care Excellence (NICE)Evidence-based clinical practice guidelines
- Centers for Disease Control and Prevention (CDC)US public health data and clinical recommendations
- PubMed – NCBIPeer-reviewed biomedical literature and clinical studies
- Cochrane LibrarySystematic reviews and meta-analyses in evidence-based medicine
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