What is appendicitis?
Appendicitis is a painful swelling and infection of the appendix.
What is the appendix?
The appendix is a fingerlike pouch attached to the large intestine
and located in the lower right area of the abdomen. Scientists are not
sure what the appendix does, if anything, but removing it does not
appear to affect a person’s health. The inside of the appendix is
called the appendiceal lumen. Mucus created by the appendix travels
through the appendiceal lumen and empties into the large intestine.
The appendix is a fingerlike pouch attached to the large intestine in the lower right area of the abdomen.
What causes appendicitis?
Obstruction of the appendiceal lumen causes appendicitis. Mucus
backs up in the appendiceal lumen, causing bacteria that normally live
inside the appendix to multiply. As a result, the appendix swells and
becomes infected. Sources of obstruction include
- feces, parasites, or growths that clog the appendiceal lumen
- enlarged lymph tissue in the wall of the appendix, caused by infection in the gastrointestinal tract or elsewhere in the body
- inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
- trauma to the abdomen
An inflamed appendix will likely burst if not removed. Bursting spreads infection throughout the abdomen—a potentially dangerous
condition called peritonitis.
Who gets appendicitis?
Anyone can get appendicitis, but it is more common among people 10
to 30 years old. Appendicitis leads to more emergency abdominal
surgeries than any other cause.
What are the symptoms of appendicitis?
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
Symptoms vary and can mimic other sources of abdominal pain, including
- intestinal obstruction
- inflammatory bowel disease
- pelvic inflammatory disease and other gynecological disorders
- intestinal adhesions
- constipation
How is appendicitis diagnosed?
A doctor or other health care provider can diagnose most cases of
appendicitis by taking a person’s medical history and performing a
physical examination. If a person shows classic symptoms, a doctor may
suggest surgery right away to remove the appendix before it bursts.
Doctors may use laboratory and imaging tests to confirm appendicitis if
a person does not have classic symptoms. Tests may also help diagnose
appendicitis in people who cannot adequately describe their symptoms,
such as children or the mentally impaired.
Medical History
The doctor will ask specific questions about symptoms and health
history. Answers to these questions will help rule out other
conditions. The doctor will want to know when the pain began and its
exact location and severity. Knowing when other symptoms appeared
relative to the pain is also helpful. The doctor will ask questions
about other medical conditions, previous illnesses and surgeries, and
use of medications, alcohol, or illegal drugs.
Physical Examination
Details about the abdominal pain are key to diagnosing appendicitis.
The doctor will assess pain by touching or applying pressure to
specific areas of the abdomen.
Responses that may indicate appendicitis include
- Guarding. Guarding occurs when a person
subconsciously tenses the abdominal muscles during an examination.
Voluntary guarding occurs the moment the doctor’s hand touches the
abdomen. Involuntary guarding occurs before the doctor actually makes
contact.
- Rebound tenderness. A
doctor tests for rebound tenderness by applying hand pressure to a
patient’s abdomen and then letting go. Pain felt upon the release of
the pressure indicates rebound tenderness. A person may also experience
rebound tenderness as pain when the abdomen is jarred—for example, when
a person bumps into something or goes over a bump in a car.
- Rovsing’s sign.
A doctor tests for Rovsing’s sign by applying hand pressure to the
lower left side of the abdomen. Pain felt on the lower right side of
the abdomen upon the release of pressure on the left side indicates the
presence of Rovsing’s sign.
- Psoas sign.
The right psoas muscle runs over the pelvis near the appendix. Flexing
this muscle will cause abdominal pain if the appendix is inflamed. A
doctor can check for the psoas sign by applying resistance to the right
knee as the patient tries to lift the right thigh while lying down.
- Obturator sign.
The right obturator muscle also runs near the appendix. A doctor tests
for the obturator sign by asking the patient to lie down with the right
leg bent at the knee. Moving the bent knee left and right requires
flexing the obturator muscle and will cause abdominal pain if the
appendix is inflamed.
Women of childbearing age may be asked to undergo a pelvic exam to
rule out gynecological conditions, which sometimes cause abdominal pain
similar to appendicitis.
The doctor may also examine the rectum, which can be tender from appendicitis.
Laboratory Tests
Blood tests are used to check for signs of infection, such as a high
white blood cell count. Blood tests may also show dehydration
or fluid and electrolyte imbalances. Urinalysis is used to rule out a
urinary tract infection. Doctors may also order a pregnancy
test for women.
Imaging Tests
Computerized tomography (CT) scans, which create cross-sectional
images of the body, can help diagnose appendicitis and other sources of
abdominal pain. Ultrasound is sometimes used to look for signs of
appendicitis, especially in people who are thin or young. An abdominal
x ray is rarely helpful in diagnosing appendicitis but can be used to
look for other sources of abdominal pain. Women of childbearing age
should have a pregnancy test before undergoing x rays or CT scanning.
Both use radiation and can be harmful to a developing fetus. Ultrasound
does not use radiation and is not harmful to a fetus.
How is appendicitis treated?
Surgery
Typically, appendicitis is treated by removing the appendix. If
appendicitis is suspected, a doctor will often suggest surgery without
conducting extensive diagnostic testing. Prompt surgery decreases the
likelihood the appendix will burst.
Surgery to remove the appendix is called appendectomy and can be
done two ways. The older method, called laparotomy, removes the
appendix through a single incision in the lower right area of the
abdomen. The newer method, called laparoscopic surgery, uses several
smaller incisions and special surgical tools fed through the incisions
to remove the appendix. Laparoscopic surgery leads to fewer
complications, such as hospital-related infections, and has a shorter
recovery time.
Surgery occasionally reveals a normal appendix. In such cases, many
surgeons will remove the healthy appendix to eliminate the future
possibility of appendicitis. Occasionally, surgery reveals a different
problem, which may also be corrected during surgery.
Sometimes an abscess forms around a burst appendix—called an
appendiceal abscess. An abscess is a pus-filled mass that results from
the body’s attempt to keep an infection from spreading. An abscess may
be addressed during surgery or, more commonly, drained before surgery.
To drain an abscess, a tube is placed in the abscess through the
abdominal wall. CT is used to help find the abscess. The drainage tube
is left in place for about 2 weeks while antibiotics are given to treat
infection. Six to 8 weeks later, when infection and inflammation are
under control, surgery is performed to remove what remains of the burst
appendix.
Nonsurgical Treatment
Nonsurgical treatment may be used if surgery
is not available, if a person is not well enough to undergo surgery, or
if the diagnosis is unclear. Some research suggests that appendicitis
can get better without surgery. Nonsurgical treatment includes
antibiotics to treat infection and a liquid or soft diet until the
infection subsides. A soft diet is low in fiber and easily breaks down
in the gastrointestinal tract.
Recovery
With adequate care, most people recover from appendicitis and do not
need to make changes to diet, exercise, or lifestyle. Full recovery
from surgery takes about 4 to 6 weeks. Limiting physical activity
during this time allows tissues to heal.
What can go wrong during the operation?
About one fifth of the patients who undergo surgery turn out to
have a ruptured (perforated) appendix. This causes peritonitis or inflammation
of the peritoneum, which is the membrane around the internal
organs.
Nowadays, this condition can be treated with
antibiotics which makes it less
dangerous than it used to be but there is still a risk of abscess formation in
the abdominal cavity which will require draining.
Adhesions from postoperative scar tissue may develop and block
or obstruct the bowel. This happens in a small number of all patients who have
their appendix surgically removed. The condition usually occurs within three
months of the operation. A bowel obstruction may require emergency
surgery.
What should people do if they think they have appendicitis?
Appendicitis is a medical emergency that requires immediate care.
People who think they have appendicitis should see a doctor or go to
the emergency room right away. Swift diagnosis and treatment reduce the
chances the appendix will burst and improve recovery time.
Points to Remember
- Appendicitis is a painful swelling and infection of the appendix.
- The appendix is a fingerlike pouch attached to the large intestine and located in the lower right area of the abdomen.
- Symptoms
of appendicitis may include abdominal pain, loss of appetite, nausea,
vomiting, constipation or diarrhea, inability to pass gas, low-grade
fever, and abdominal swelling.
- A doctor can diagnose most
cases of appendicitis by taking a person’s medical history and
performing a physical examination. Sometimes laboratory and imaging
tests are needed to confirm the diagnosis.
- Appendicitis is typically treated by removing the appendix.
- Appendicitis is a medical emergency that requires immediate care.
