Digestive Diseases: Appendicitis

Appendicitis is an inflammation of the appendix, a 3 1/2-inch-long tube of tissue that extends from the large intestine. The appendix contains specialized tissue that can produce antibodies, but no one is absolutely certain what its function is. One thing we do know: We can live without it, without apparent consequences.

Appendicitis is a medical emergency that requires prompt surgery to remove the appendix. Left untreated, an inflamed appendix will eventually burst, or perforate, spilling infectious materials into the abdominal cavity. This can lead to peritonitis, a serious inflammation of the abdominal cavity's lining (the peritoneum) that can be fatal unless it is treated quickly with strong antibiotics.

Sometimes a pus-filled abscess (infection that is walled off from the rest of the body) forms outside the inflamed appendix. Scar tissue then "walls off" the appendix from the rest of the abdomen, preventing infection from spreading. An abscessed appendix is a less urgent situation, but unfortunately, it can't be identified without surgery. For this reason, all cases of appendicitis are treated as emergencies requiring surgery.

In the U.S., 1 in 15 people will get appendicitis. Although it can strike at any age, appendicitis is rare under age 2 and most common between ages 15 and 30.

Appendicitis occurs when the appendix becomes blocked, often by stool, a foreign body, or cancer. Blockage may also occur from infection, since the appendix swells in response to any infection in the body.

The classic symptoms of appendicitis include:

Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right abdomen. This is usually the first sign.

• Loss of appetite
• Nausea and/or vomiting soon after abdominal pain begins
• Abdominal swelling
• Fever of 99° F to 102° F
• Inability to pass gas

Almost half the time, other symptoms appear, including:

• Dull or sharp pain anywhere in the upper or lower abdomen, back, or rectum
• Painful urination
• Vomiting that precedes the abdominal pain
• Severe cramps
• Constipation or diarrhea with gas

Call Your Doctor If:

You have pain that matches these symptoms. Do not eat, drink, or use any pain remedies, antacids, laxatives, or heating pads, which can cause an inflamed appendix to rupture. If you have any of the mentioned symptoms seek medical attention immediately since timely diagnosis and treatment is very important. If you have any of the mentioned symptoms, seek medical attention immediately since timely diagnosis and treatment is very important.

Diagnosing appendicitis can be tricky. Appendicitis symptoms are frequently vague or extremely similar to other ailments, including gallbladder problems, bladder or urinary tract infection, Crohn's disease, gastritis, intestinal infection, and ovary problems.

The following tests are usually used to make the diagnosis.

• Abdominal exam to detect inflammation
• Urine test to rule out a urinary tract infection
• Rectal exam
• Blood test to see if your body is fighting infection
• CT scans and/or ultrasound

Surgery to remove the appendix, which is called an appendectomy, is the standard treatment for appendicitis.

If appendicitis is even suspected, doctors tend to err on the side of safety and quickly remove the appendix to avoid its rupture. If the appendix has formed an abscess, you may have two procedures: one to drain the abscess of pus and fluid, and a later one to remove the appendix.

Antibiotics are given before an appendectomy to fight possible peritonitis. General anesthesia is usually given, and the appendix is removed through a 4-inch incision or by laparoscopy. If you have peritonitis, the abdomen is also irrigated and drained of pus.

Within 12 hours of surgery you may get up and move around. You can usually return to normal activities in 2 to 3 weeks. If surgery is done with a laparoscope (a thin telescope-like instrument for viewing inside the abdomen), the incision is smaller and recovery is faster.

After an appendectomy, call your doctor if you have:

• Uncontrolled vomiting.
• Increased pain in your abdomen.
• dizziness/feelings of faintness.
• Blood in your vomit or urine.
• Increased pain and redness in your incision.
• Fever.
• Pus in the wound.

There is no way to prevent appendicitis. However, appendicitis is less common in people who eat foods high in fiber, such as fresh fruits and vegetables.

Reviewed by The Cleveland Clinic Department of Gastroenterology.
Edited by Louise Chang, MD, WebMD, November 2005.

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