- What is appendicitis?
- What causes appendicitis?
- What are symptoms of appendicitis?
- How is appendicitis diagnosed?
- What is the treatment for appendicitis?
- What are the complications appendicitis?
- Points to remember about appendicitis?
- Hope through research for appendicitis
- For more information on 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
- 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
- people who use immunosuppressive therapy such as steroids
- people who have received a transplanted organ
- people infected with the HIV virus
- people with diabetes
- people who have cancer or who are receiving chemotherapy
- obese people
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.
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).
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 Society of Colon and
Rectal Surgeons (ASCRS)
85 West Algonquin Road Suite 550
Arlington Heights, IL 60005
Email: [email protected]
National Library of Medicine-MEDLINEplus
Source: National Digestive Diseases Information Clearinghouse (NDDIC), National Institutes of Health
Health Solutions From Our Sponsors
Top Appendicitis Related Articles
Abdominal Pain (Causes, Remedies, Treatment)Abdominal pain can have many causes that range from mild to severe. Some of these causes include bloating, gas, colitis, endometriosis, food poisoning, GERD, IBS (irritable bowel syndrome), ovarian cysts, abdominal adhesions, diverticulitis, Crohn's disease, ulcerative colitis, gallbladder disease, liver disease, and cancers. Signs and symptoms of the more serious causes include dehydration, bloody or black tarry stools, severe abdominal pain, pain with no urination or painful urination. Treatment for abdominal pain depends upon the cause.
Abdominal Pain PicturesAbdominal pain is a symptom of many possible conditions including appendicitis, ulcers, irritable bowel syndrome, indigestion, and other conditions. It may accompany constipation, diarrhea, vomiting, and other symptoms. Find out the potential causes of pain in the abdomen and learn when you should see a doctor.
AppendectomyAppendectomy is the removal by surgery of the appendix, the small worm-like appendage of the colon (the large bowel). An appendectomy is performed because of probable appendicitis, inflammation of the wall of the appendix generally associated with infection.
How Long Does It Take to Recover from An Appendectomy?Appendectomy is the surgical removal of the appendix. It is most often performed as an emergency surgery for appendicitis. With a laparoscopic surgery, a patient is often able to resume normal activities in one to three weeks. An open surgery may require about two to four weeks for recovery. With a ruptured appendix, it may take up to six weeks or more.
Appendicitis SlideshowWhat causes appendicitis? Appendix pain can lead to appendicitis. Learn about appendicitis symptoms and signs. Explore the steps of an appendectomy.
Appendicitis QuizHow dangerous is appendicitis? Take this quiz to answer questions, get quick facts, and learn the causes of appendicitis as well as symptoms, risks, and treatments for this common condition.
Illustrations of AppendixFront View of the Appendix. The appendix sits at the junction of the small intestine and large intestine. See a picture of the Appendix and learn more about the health topic.
CT Scan (Computerized Tomography)A CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.
Cramps but No PeriodHaving cramps but no period can occur because of conditions other than your monthly menstrual cycle. They may feel like period cramps of the lower abdomen when you are not due for your period and produce no blood. These 12 diseases and conditions are examples of what can cause abdominal cramping when not on period.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. The causes of night sweats in most people are not serious, like menopause in women, sleep apnea, medications, alcohol withdrawal, and thyroid problems. However, more serious diseases like cancer and HIV also can cause night sweats. Your doctor will treat your night sweats depending upon the cause.
You may experience other signs and symptoms that are associated with night sweats, which depend upon the cause, but may include, shaking, and chills with a fever caused by an infection like the flu or pneumonia; unexplained weight loss due to lymphoma; women in perimenopause or menopause may also have vaginal dryness, mood swings, and hot flashes during the day; and low blood sugar in people with diabetes.
Other causes of night sweats include medications like NSAIDs (aspirin, acetaminophen, ibuprofen (Motrin, Advil), and naproxen (Aleve, Naprosyn), antidepressants, sildenafil (Viagra), and abuse of prescription or illegal drugs and drug withdrawal; hormone disorders like pheochromocytoma and carcinoid syndrome; idiopathic hyperhidrosis; infections like endocarditis, AIDs, and abscesses; alcoholism and alcohol withdrawal; drug abuse, addiction, and withdrawal; and stroke.
A doctor or other health care professional can treat your night sweats after the cause has been diagnosed.
Pelvic Pain SlideshowThere are many causes of pelvic pain in women including cysts, PMS, appendicitis, and bladder infections. Pelvic pain has uncomfortable symptoms, but luckily there are treatments for pelvic pain.
Sedimentation RateA sedimentation rate is a common blood test that is used to detect and monitor inflammation in the body. It is performed by measuring the rate at which red blood cells (RBCs) settle in a test tube. The sedimentation rate is simply how far the top of the RBC layer has fallen in one hour, increasing with more inflammation.
Shock (Medical)Medical shock is a life-threatening medical condition. There are several types of medical shock, including:
- septic shock,
- anaphylactic shock,
- cardiogenic shock,
- hypovolemic shock, and
- neurogenic shock.
- heart attack,
- heart failure,
- heavy bleeding (internal and external),
- spinal cord injury,
- severe burns,
- chronic vomiting or
UltrasoundUltrasound (and ultrasonography) is imaging of the body used in the medical diagnosis and screening of diseases and conditions such as:
- heart valve irregularities,
- carotid artery disease,
- heart disease,
- kidney stones,
- liver disease,
- diseases of the female reproductive, and
- diseases of the male reproductive organs.
Why Am I So Bloated and Gassy?Bloating is a feeling that your abdomen is distended or larger than normal, but it does not necessarily mean that it is. Gas (flatulence) also can be a problem if you are bloated. Common, less serious causes of bloating are eating too fast, too much, or too many fatty foods; swallowing air; pregnancy; and menstruation. Cancer and IBD (ulcerative colitis and Crohn's disease) are examples the more serious causes of bloating. Examples of foods and drinks that cause bloating are high fiber foods if you don't eat them regularly; eventually the bloating and gassiness will resolve if you eat them on a regular basis; fatty greasy foods, dairy products (for example, cheese, ice cream, milk, and yogurt); foods high in salt (for example, processed, frozen, and canned foods), and artificial sweeteners.
Some doctors and other health care professionals recommend natural remedies like chamomile or peppermint tea, or pumpkin to relieve bloating. Examples of OTC medicine (medicine available without a prescription) and other products that may relieve bloating and gassiness are, Gas-X, Beano, Pepto Bismol, Metamucil, probiotics, and Ex-Lax for constipation associated with bloating. If you have persistent or severe gas and bloating, and if you have any of these symptoms see a doctor or other healthcare professional, shortness of breath, heart palpitations, chest pain, bloody diarrhea, fever, or if you think you are or may be pregnant.