Appendicitis is inflammation of the appendix that should be checked by a doctor, who will assess your symptoms and order tests to confirm a diagnosis.
What are the signs and symptoms of appendicitis?
Appendicitis pain may have the following characteristics:
- Sudden and sharp
- Starts around the navel and shifts to the lower right abdomen, although sometimes the upper abdomen and sides may be affected as well
- Worsens when you cough, sneeze, or move
Other signs and symptoms of appendicitis may include:
- Loss of appetite
- Inability to pass gas
- Abdominal swelling
- Abdominal bloating
How is appendicitis diagnosed?
In order to rule out other causes of your abdominal pain and confirm a diagnosis of appendicitis, your doctor will take your medical history, perform a physical exam, and order the following tests:
- White blood cell count: Checks for infection and its severity.
- Electrolyte levels: Check for electrolyte imbalance due to dehydration.
- C-reactive protein levels: Checks for other causes of inflammation.
- Urine test: Detects whether your abdominal pain is due to a urinary tract problem such as a bladder infection or kidney stone.
- Urine pregnancy test: Helps determine whether the pain is caused by an unplanned pregnancy.
- Imaging tests: Shows whether the cause of your abdominal pain is due to an infection of the appendix, blockage inside the appendix, a burst appendix, an abscess, or something else. These tests include:
- Abdominal ultrasound: A small wand-like device is used to scan your abdomen and create an image of your internal organs. Unlike X-rays, it does not involve radiation. However, the presence of abdominal gas and food can interfere with results.
- Computed tomography (CT) scan: A series of X-ray images taken from different angles create cross-sectional images of your organs, bones, and blood vessels and can provide a more detailed view of your abdomen than plain X-rays.
- Magnetic resonance imaging (MRI): MRI scans use a strong magnetic field and radio waves to take detailed pictures of your internal organs and soft tissues. It offers the best chance at accurate diagnosis.
If the diagnosis is still uncertain, your doctor may recommend a laparoscopy to examine your appendix and pelvic organs. Diagnostic tests can help rule out other causes of abdominal pain that include:
- Bladder infection
- Kidney stones
- Inflammatory bowel disease
- Crohn’s disease
- Ulcerative colitis
- Intestinal obstruction (blockage that obstructs the passage of food or liquids through your small intestine or colon)
- Abdominal adhesions (bands of scar-like tissue that form inside your abdomen)
- Pelvic inflammatory disease
- Female reproductive problems
What causes appendicitis?
Appendix is a small, fingerlike structure at the junction of the small and large intestine. The function of the appendix is largely unknown, and removal seems to not cause any observable problems. However, infection of the appendix can be painful.
Some experts believe that appendicitis is caused by repeated infection in the appendicular lumen, whereas others say it is an autoimmune reaction caused by the presence of a large amount of lymph tissue in the appendix. Another theory is that it may be caused by hormonal changes, as many cases are reported around puberty.
In many cases, appendicitis is caused by a blockage at the entrance of the appendix that results in infection. The blockage may be due to:
- Small piece of feces
- Lymph node swelling inside the abdomen caused by:
- Crohn’s disease
- Respiratory infections
You can get appendicitis at any age, but it usually affects individuals between ages 10-30.
How is appendicitis treated?
Initial treatment of appendicitis involves antibiotics. However, if you get frequent attacks of appendicitis (chronic appendicitis) or your doctor suspects that the infection has spread deeply and extensively, they will plan an appendectomy.
An appendectomy is a surgical procedure that involves the removal of the appendix and can be done in two ways:
- Open appendectomy: A single, large cut (about 2-3 inches) is made over your abdomen (laparotomy) to remove your appendix.
- Laparoscopic appendectomy: A laparoscope (thin, flexible, long, tube-like camera) is inserted after making multiple small cuts in the abdomen. The appendix is then removed with surgical tools.
Your doctor will recommend an appendectomy if your appendix gets infected and inflamed and causes pain. If the infected appendix is not removed in time, it can turn into an abscess or burst and infect the entire abdomen (peritonitis). Both are life-threatening conditions and require urgent medical treatment.
In cases of subacute appendicitis, the inflammation is not marked and temporary relief can be achieved with intravenous antibiotic therapy and painkillers. However, eventually, surgery is the only option. Nonsurgical interventions are mainly used with children, if the surgeon wants to wait and see or does not want to operate at such a young age.
What are complications of an appendectomy?
Any surgery carries some risks of complications. Potential complications of an appendectomy include:
- Internal bleeding
- Infection of the surgical wound
- Abdominal abscess (pus in the abdomen)
- Enteric injury (injury to the intestine)
- Fistula (formation of a cavity in the abdomen that oozes fluid)
Other complications that can occur in the long term include:
- Incisional hernia: Incisional hernia refers to the bulging of the surgical scar that occurs when the surgical cut does not heal properly after an appendectomy.
- Stump appendicitis: This occurs if a small piece of the appendix is accidentally left in the abdomen during the operation and gets infected.
- Small-bowel obstruction: This is a partial or complete blockage in the small intestine. With appendicitis, it may develop from the surgical scar of an appendectomy.
You should avoid strenuous physical activities for about 4-6 weeks after the appendectomy in order to promote healing of the surgical wound.
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