Appendicitis
The appendix is a small, tube-like structure attached to the first part of
the large intestine, also called the colon. The appendix is located in the lower
right portion of the abdomen. It has no known function. Removal of the appendix
appears to cause no change in digestive function.
Appendicitis is an inflammation of the appendix. Once it
starts, there is no effective medical therapy, so appendicitis is considered a
medical emergency. When treated promptly, most patients recover without
difficulty. If treatment is delayed, the appendix can burst, causing infection
and even death. Appendicitis is the most common acute surgical emergency of the abdomen. Anyone can get
appendicitis, but it occurs most often between the ages of 10 and 30.
The appendix is a
small, tube-like structure attached to the first part of the large intestine, also called the colon. The appendix is
located in the lower right portion of the abdomen, near where the small
intestine attaches to the large intestine.
The cause of appendicitis relates to blockage of the inside of the appendix,
known as the lumen. The blockage
leads to increased pressure, impaired blood
flow, and inflammation. If the blockage is not treated, gangrene and rupture
(breaking or tearing) of the appendix can result.
Most commonly, feces blocks the inside of the appendix. Also, bacterial or
viral infections in the digestive tract can lead to swelling of lymph nodes, which
squeeze the appendix and cause obstruction. This swelling of lymph nodes
is known as lymphoid hyperplasia. Traumatic
injury to the abdomen may lead to
appendicitis in a small number of people. Genetics may be a factor in others.
For example, appendicitis that runs in families may result from a genetic
variant that predisposes a person to obstruction of the appendiceal lumen.
Symptoms of appendicitis may include
- pain in the abdomen, first around the belly button, then moving to the lower right area
- loss of appetite
- nausea
- vomiting
- constipation or diarrhea
- inability to pass gas
- low fever that begins after other symptoms
- abdominal swelling
Not everyone with appendicitis has all the symptoms. The
pain intensifies and worsens when moving, taking deep breaths, coughing, or
sneezing. The area becomes very tender. People may have a sensation called "downward urge," also
known as "tenesmus," which is
the feeling that a bowel movement will relieve
their discomfort. Laxatives and pain medications should not be taken in this
situation. Anyone with these symptoms needs to see a qualified physician
immediately.
People With Special Concerns
Patients with special conditions may not have the set of
symptoms above and may simply experience a general feeling of being unwell. Patients with these
conditions include
Pregnant women, infants and young children, and the elderly have particular
issues.
Abdominal pain, nausea, and vomiting are more common
during pregnancy and may or may not be the signs of appendicitis. Many women who
develop appendicitis during pregnancy do not experience the classic symptoms.
Pregnant women who experience pain on the right side of the abdomen need to
contact a doctor. Women in their third trimester are most at risk.
Infants and young children cannot communicate their pain history to parents
or doctors. Without a clear history, doctors must rely on a physical exam and
less specific symptoms, such as vomiting and fatigue. Toddlers with appendicitis
sometimes have trouble eating and may seem unusually sleepy. Children may have
constipation, but may also have small stools that contain mucus. Symptoms vary
widely among children. If you think your child has appendicitis, contact a
doctor immediately.
Older patients tend to have more medical problems than young patients. The
elderly often experience less fever and less severe abdominal pain than other
patients do. Many older adults do not know that they have a serious problem
until the appendix is close to rupturing. A slight fever and abdominal pain on
one's right side are reasons to call a doctor right away.
All patients with special concerns and their families need to be particularly
alert to a change in normal functioning and patients should see their doctors
sooner, rather than later, when a change occurs.
Medical History and Physical Examination Asking questions to learn the history of
symptoms and a careful physical examination are key in the diagnosis of
appendicitis. The doctor will ask many questions-much like a reporter-trying to
understand the nature, timing, location, pattern, and severity of pain and
symptoms. Any previous medical conditions and surgeries, family history,
medications, and allergies are important information to the doctor. Use of
alcohol, tobacco, and any other drugs should also be mentioned. This information
is considered confidential and cannot be shared without the permission of the
patient.
Before beginning a physical examination, a nurse or
doctor will usually measure vital signs: temperature, pulse rate, breathing
rate, and blood pressure. Usually the physical examination proceeds from head to
toe. Many conditions such as pneumonia or heart disease can
cause abdominal pain. Generalized symptoms such as fever, rash, or swelling of
the lymph nodes may point to diseases that wouldn't require surgery.
Examination of the abdomen helps narrow the diagnosis.
Location of the pain and tenderness is important. Pain is a symptom described by a patient;
tenderness is the response to being touched. Two signs, called peritoneal signs,
suggest that the lining of the abdomen is inflamed and surgery may be needed:
rebound tenderness and guarding. Rebound tenderness is when the doctor presses
on a part of the abdomen and the patient feels more tenderness when the pressure
is released than when it is applied. Guarding refers to the tensing of muscles
in response to touch. The doctor may also move the patient's legs to test for
pain on flexion of the hip (psoas sign), pain on internal rotation of the hip
(obturator sign), or pain on the right side when pressing on the left (Rovsing's
sign). These are valuable indicators of inflammation but not all patients have
them.
Laboratory Tests
Blood tests are used to check for signs of infection,
such as a high white blood cell count. Blood chemistries may also show
dehydration or fluid and
electrolyte disorders. Urinalysis is used to rule out a urinary tract infection.
Doctors may also order a pregnancy test for women of childbearing age (those who
have regular periods).
Imaging Tests
X rays, ultrasound, and computed tomography (CT) scans
CAT scan can produce images of the abdomen. Plain x rays can show signs of
obstruction, perforation (a hole), foreign bodies, and in rare cases, an
appendicolith, which is hardened stool in the appendix. Ultrasound may show
appendiceal inflammation and can diagnose gall bladder disease and pregnancy. By
far the most common test used, however, is the CT scan. This test provides a
series of cross-sectional images of the body and can identify many abdominal
conditions and facilitate diagnosis when the clinical impression is in doubt. All women of childbearing age should have a
pregnancy test before undergoing any testing with x rays.
In selected cases, particularly in women when the cause of the symptoms may
be either the appendix or an inflamed ovary or fallopian tube,
laparoscopy may be necessary. This procedure avoids radiation, but requires general anesthesia.
A laparoscope is a thin
tube with a camera attached that is inserted into the body through a small cut,
allowing doctors to see the internal organs. Surgery can then be performed
laparoscopically if the condition present requires it.
Surgery Acute appendicitis is treated by surgery to
remove the appendix. The operation may be performed through a standard small
incision in the right lower part of the abdomen, or it may be performed using a
laparoscope, which requires three to four smaller incisions. If other conditions
are suspected in addition to appendicitis, they may be identified using
laparoscopy. In some patients, laparoscopy is preferable to open surgery because
the incision is smaller, recovery time is quicker, and less pain medication is required. The appendix is
almost always removed, even if it is found to be normal. With complete removal,
any later episodes of pain will not be attributed to appendicitis.
Recovery from appendectomy takes a few weeks. Doctors usually prescribe pain
medication and ask patients to limit physical activity. Recovery from
laparoscopic appendectomy is generally faster, but limiting strenuous activity
may still be necessary for 4 to 6 weeks after surgery. Most people treated for
appendicitis recover excellently and rarely need to make any changes in their
diet, exercise, or lifestyle.
Antibiotics and Other Treatments
If the diagnosis is uncertain, people may be watched and sometimes treated
with antibiotics. This approach is taken when the doctor suspects that the
patient's symptoms may have a nonsurgical or medically treatable cause. If the
cause of the pain is infectious, symptoms resolve with intravenous antibiotics
and intravenous fluids. In general, however, appendicitis cannot be treated with
antibiotics alone and will require surgery.
Occasionally the body is able to control an appendiceal perforation by
forming an abscess. An abscess
occurs when an infection is walled off in one part of the body. The doctor may
choose to drain the abscess and leave the drain
in the abscess cavity for several weeks. An appendectomy may be scheduled after
the abscess is drained.
The most serious complication of appendicitis is rupture. The appendix bursts
or tears if appendicitis is not diagnosed quickly and goes untreated. Infants,
young children, and older adults are at highest risk. A ruptured appendix can
lead to peritonitis and abscess. Peritonitis is a dangerous infection that
happens when bacteria and other contents of the torn appendix leak into the
abdomen. In people with appendicitis, an abscess usually takes the form of a
swollen mass filled with fluid and bacteria. In a few patients, complications of
appendicitis can lead to organ failure and death.
- The appendix is a small, tube-like structure attached
to the first part of the colon. Appendicitis is an inflammation of the
appendix.
- Appendicitis is considered a medical emergency.
- Symptoms of appendicitis include pain in the abdomen,
loss of appetite, nausea, vomiting, constipation or diarrhea, inability to
pass gas, low-grade fever, and abdominal swelling. Not everyone with
appendicitis has all the symptoms.
- Physical examination, laboratory tests, and imaging
tests are used to diagnose appendicitis.
- Acute appendicitis is treated by surgery to remove the
appendix.
- The most serious complication of appendicitis is rupture, which can lead
to peritonitis and abscess.
The National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK)
conducts and supports research into many kinds of digestive disorders, including
some related to appendicitis.
American Academy of Family Physicians
P.O. Box 11210
Shawnee Mission, KS 66207-1210?
Phone: 1-800-274-2237
Email: fp@aafp.org
Internet: www.aafp.org
American College of Surgeons
633 North Saint Clair Street
Chicago, IL 60611-3211
Phone: 312-202-5000
Fax: 312-202-5001
Email: postmaster@facs.org
Internet: www.facs.org
American Society of Colon and
Rectal Surgeons (ASCRS)
85 West Algonquin Road Suite 550
Arlington Heights, IL 60005
Phone: 847-290-9184
Fax: 847-290-9203
Email: ascrs@fascrs.org
Internet: www.fascrs.org
National Library of Medicine-MEDLINEplus
Internet:
www.nlm.nih.gov/medlineplus
Source: National Digestive Diseases Information Clearinghouse (NDDIC),
National Institutes of Health
Last Editorial Review: 2/7/2006
- CT Scan (Computerized Axial Tomography) - CT Scan (Computerized Axial Tomography, CAT scan) is a procedure that assists in diagnosing tumors, fractures, bony structures, and infections in the organs and tissues of the body.
- Abdominal Pain - Learn about abdominal pain (pain in the stomach / abdomen) including causes, symptoms, how abdominal pain is diagnosed, and how abdominal pain is treated.
- Ultrasound - Learn an ultrasound procedure, and conditions and diseases it assists in diagnosing and screening like tumors, cysts, heart conditions and more.
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