What is the appendix?
Untreated appendicitis can lead to a ruptured, or burst, appendix. If your appendix ruptures, the infection will leak into your abdominal cavity and cause peritonitis. Peritonitis is an inflammation in the lining of your abdomen. This can be life-threatening. The treatment for a ruptured appendix is immediate surgery to remove the appendix and clean the infection out of your abdominal cavity. The appendix is a small organ located in the lower right of your abdomen. It is joined to your large intestine. While it used to be thought to have no function, some studies have shown that it may have a purpose in healthy immune system function by acting as a storage space for beneficial gut bacteria.
Though its function is still being studied, the appendix is usually only thought of when something goes wrong with it, resulting in appendicitis. Appendicitis is an inflammation of the appendix, usually caused by an infection or blockage.
Appendicitis can occur at any age but is most common in people aged 10 to 30. Without treatment, the appendix may rupture, which can lead to a serious infection known as peritonitis. Appendicitis is a medical emergency and requires immediate treatment, usually surgery to remove the appendix.
Symptoms of appendicitis
Symptoms of appendicitis may include any of the following:
- Pain on the right side of your abdomen that begins suddenly
- Abdominal pain that gets significantly worse
- Abdominal pain that is worse with movement, such as coughing or walking
- Pain that wakes you from sleep
- Nausea and vomiting
- Loss of appetite
- Diarrhea or constipation
- Fever that may get worse
- Excess gas or an inability to pass gas
Causes of appendicitis
The cause of appendicitis is not always clear, but it's usually related to one of the following reasons:
Infection is one of the most common causes of appendicitis. A viral or bacterial infection causes the appendix to swell and fill with pus. The inflammation blocks blood flow to the appendix, which then starts to die. At this point, it can develop holes or tears or even burst if not treated. If that happens, stool, pus, and mucus can leak into the abdominal cavity, resulting in a life-threatening infection.
Sometimes, appendicitis can be caused by fecal matter blocking the appendix. Normally, the appendix is open to the large intestine. When stool or bacteria from an infection gets into the appendix, it becomes blocked. This blockage leads to inflammation and swelling.
Rarely, appendicitis can be caused by tumors, both benign, or non-cancerous, and cancerous tumors. These tumors are usually discovered when the appendix is removed because of appendicitis or during diagnostic tests for other issues.
Inflammatory bowel disease is a term that covers inflammatory diseases of the intestines such as Crohn's disease and ulcerative colitis. This chronic inflammation can lead to inflammation of the appendix as well.
Though it's fairly infrequent, abdominal trauma can lead to appendicitis. This happens when there is a blunt injury to the abdomen that causes a blockage of the appendix.
When to see the doctor for appendicitis
Appendicitis is a medical emergency that should be treated immediately. If you have any symptoms of appendicitis call your doctor or go to the emergency room. Appendicitis can progress quickly, so you shouldn't wait to seek treatment.
Your doctor will likely use some of the following options to diagnose appendicitis.
After hearing your symptoms, your doctor will conduct a physical exam to check for signs of appendicitis.
If your doctor gently presses on your stomach and the pain is worse when the pressure is lifted, that can be a sign of inflammation in the peritoneum, which is the lining of the abdomen. Additionally, your doctor may check for signs that your abdomen is rigid or that you are stiffening the muscles of your abdomen in response to pressure.
Another sign of appendicitis on a physical exam is called the Rovsing sign, which is present when pressure on the left side of your abdomen increases the pain on the right side. If you are a woman, your doctor may also perform a pelvic exam to rule out other causes of abdominal pain.
Your doctor will do a blood test to check for a high white blood cell count (CBC), which indicates infection.
Once other causes have been ruled out, your doctor will probably order an imaging study to confirm appendicitis. A test such as an X-ray, ultrasound, magnetic resonance imaging (MRI), or computerized tomography (CT) will let your doctor better visualize what is going on inside your body and determine if it is appendicitis or another medical issue.
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Treatments for appendicitis
Appendicitis is usually treated by removal of the appendix and antibiotics. If it is a mild, uncomplicated case, it may be treated with only antibiotics, but this is not as common.
Surgery for appendicitis is done with one of the methods below:
Using this method, several small incisions are made in the abdomen to remove your appendix. This type of surgery has few complications and is not as risky as more invasive types of surgery.
In this type of surgery, which is also called an open appendectomy, a single incision is made to the lower right abdomen to remove the appendix. This may be the best option if your appendix has ruptured or you have an abscess that needs to be drained before surgery.
In either case, you may have to spend one or two days in the hospital after surgery before you're sent home to recover. An open appendectomy will require 10 to 14 days of healing time while a laparoscopic one will only require 3 to 5 days. During the postoperative period, you should get plenty of rest, avoid strenuous activity, and report any concerning symptoms to your doctor.
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The American Journal of Emergency Medicine: "Appendicitis following blunt abdominal trauma."
The BMJ: " Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials."
Brigham Health: "Appendix Tumors."
JAMA Surgery: "Association of Viral Infection and Appendicitis."
John Hopkins Medicine: "Appendicitis."
Mayo Clinic: "Inflammatory Bowel Disease."
Mayo Clinic: "Symptoms and Causes: Appendicitis."
National Institute of Diabetes and Digestive and Kidney Disease: "Symptoms and Causes of Appendicitis."
Palevol Reports: "Morphological evolution of the mammalian cecum and cecal appendix."
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Appendicitis is an inflammation of the appendix. Appendicitis often causes sings and symptoms such as abdominal pain in the lower right quadrant, nausea, vomiting, abdominal tenderness, fever, and loss of appetite.
Delay in surgery can result in appendix rupture with potentially serious complications.
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