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Appendicitis


The appendix is a narrow tubular pouch attached to the intestines. When the appendix is blocked, it becomes inflamed and results in a condition termed appendicitis. If the blockage continues, the inflamed tissue becomes infected with bacteria and begins to die from a lack of blood supply, which finally results in the rupture of the appendix (perforated or ruptured appendix).

Individuals of any age may be affected, with the highest incidence occurring in the teens and twenties; however, rare cases of neonatal and prenatal appendicitis have been reported. Increased vigilance in recognizing and treating potential cases of appendicitis is critical in the very young and elderly, as this population has a higher rate of complications. Appendicitis is the most common pediatric condition requiring emergency abdominal surgery.

Appendicitis Causes

There is no clear cause of appendicitis.

Fecal material is thought to be one possible cause of obstruction of the appendix. Bacteria, viruses, fungi, and parasites can result in infection, leading to the swelling of the tissues of the appendix wall. Swelling of the tissue from inflammatory bowel disease such as Crohn's disease also may cause appendicitis. Appendicitis is not a hereditary disease and is not transmittable from person to person.

Appendicitis Symptoms and Signs

Most people with appendicitis have classic symptoms that a doctor can easily identify. The main symptom of appendicitis is abdominal pain.

The abdominal pain usually

occurs suddenly, often causing a person to wake up at night
occurs before other symptoms
begins near the belly button and then moves lower and to the right
is new and unlike any pain felt before
gets worse in a matter of hours
gets worse when moving around, taking deep breaths, coughing, or sneezing

Other symptoms of appendicitis may include

loss of appetite
nausea
vomiting
constipation or diarrhea
inability to pass gas
a low-grade fever that follows other symptoms
abdominal swelling
the feeling that passing stool will relieve discomfort

When to Seek Medical Care

Call a health care practitioner if there are acute symptoms of middle/lower or right/lower abdominal pain with fever and/or vomiting.
If symptoms of abdominal pain continue for more than four hours, an urgent medical evaluation should be performed at the health care practitioner's office or a hospital's emergency department.

Appendicitis Diagnosis

Appendicitis is diagnosed by the classic symptoms of appendicitis and physical examination (the health care practitioner's examination of the patient's abdomen).

Lab work: Although no blood test can confirm appendicitis, a blood sample is sent for laboratory analysis to check the white blood cell count, which is typically elevated in an individual with appendicitis. However, normal levels can be present with appendicitis, and elevated levels can be seen with other conditions. A urinalysis may be ordered to exclude urinary tract infection (or pregnancy) as the cause of the patient's symptoms.

Imaging tests: Imaging tests are ordered when the diagnosis is not readily apparent. Most medical centers utilize a CT scan of the abdomen and pelvis to assist in evaluating abdominal pain suspected of being caused by appendicitis. Ultrasound scanning is commonly used in small children to test for appendicitis in order to avoid exposing the child to radiation from CT scans.

Other conditions that cause abdominal pain may mimic the symptoms of appendicitis making the diagnosis more difficult. These conditions include kidney stones, urinary tract infections, hernias, gallstones and gallbladder problems, colitis, diverticulitis, and ovarian or testicular problems.

Appendicitis Treatment

Appendicitis Self-Care at Home

There is no home care for appendicitis. If appendicitis is suspected, contact a health care practitioner or go to an emergency department. Avoid eating or drinking as this may complicate or delay surgery. If you are thirsty, you may rinse your mouth with water. Do not use laxatives, antibiotics, or pain medications because these may cause delay in diagnosis that increases the risk of rupture of the appendix or mask the symptoms, which makes diagnosis more difficult.

Surgery (Appendectomy)

The best treatment for appendicitis is surgery to remove the appendix (appendectomy) before the appendix ruptures. While awaiting surgery, the patient will be given IV fluids to keep well hydrated. The patient will not be allowed to eat or drink because doing so may cause complications with the anesthesia during surgery.