What Is Appendicitis?
Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a ruptured appendix include widespread, painful inflammation of the inner lining of the abdominal wall and sepsis.
Appendicitis is caused by a blockage of the hollow portion of the appendix. This is most commonly due to a calcified “stone” made of feces. Inflamed lymphoid tissue from a viral infection, parasites, gallstone, or tumors may also cause the blockage. This blockage leads to increased pressures in the appendix, decreased blood flow to the tissues of the appendix, and bacterial growth inside the appendix causing inflammation. The combination of inflammation, reduced blood flow to the appendix and distention of the appendix causes tissue injury and tissue death. If this process is left untreated, the appendix may burst, releasing bacteria into the abdominal cavity, leading to increased complications.
The diagnosis of appendicitis is largely based on the person’s signs and symptoms. In cases where the diagnosis is unclear, close observation, medical imaging, and laboratory tests can be helpful. The two most common imaging tests used are an ultrasound and computed tomography (CT scan). CT scan has been shown to be more accurate than ultrasound in detecting acute appendicitis. However, ultrasound may be preferred as the first imaging test in children and pregnant women because of the risks associated with radiation exposure from CT scans.
If you have appendicitis, you may experience one or more of the following symptoms:
- pain in your upper abdomen or around your bellybutton
- pain in the lower right side of your abdomen
- loss of appetite
- abdominal swelling
- inability to pass gas
- low-grade fever
Appendicitis pain may start off as mild cramping. It often becomes more steady and severe over time. It may start in your upper abdomen or bellybutton area, before moving to the lower right quadrant of your abdomen.
If you’re constipated and you suspect that you may have appendicitis, avoid taking laxatives or using an enema. These treatments may cause your appendix to burst.
Contact your doctor if you have tenderness in the right side of your abdomen along with any of other symptoms of appendicitis. Appendicitis can quickly become a medical emergency. Get the information you need to recognize this serious condition.
In many cases, the exact cause of appendicitis is unknown. Experts believe it develops when part of the appendix becomes obstructed, or blocked.
Many things can potentially block your appendix, including:
- a buildup of hardened stool
- enlarged lymphoid follicles
- intestinal worms
- traumatic injury
When your appendix becomes blocked, bacteria can multiply inside it. This can lead to the formation of pus and swelling, which can cause painful pressure in your abdomen.
Other conditions can also cause abdominal pain. Click here to read about other potential causes of pain in your lower right abdomen.
Tests for appendicitis
If your doctor suspects you might have appendicitis, they will perform a physical exam. They will check for tenderness in the lower right part of your abdomen and swelling or rigidity.
Depending on the results of your physical exam, your doctor may order one or more tests to check for signs of appendicitis or rule out other potential causes of your symptoms.
There’s no single test available to diagnose appendicitis. If your doctor can’t identify any other causes of your symptoms, they may diagnose the cause as appendicitis.
Complete blood count
To check for signs of infection, your doctor may order a complete blood count (CBC). To conduct this test, they will collect a sample of your blood and send it to a lab for analysis.
Appendicitis is often accompanied by bacterial infection. An infection in your urinary tract or other abdominal organs may also cause symptoms similar to those of appendicitis.
To rule out urinary tract infection or kidney stones as a potential cause of your symptoms, your doctor may use urinalysis. This is also known as a urine test.
Your doctor will collect a sample of your urine that will be examined in a lab.
Ectopic pregnancy can be mistaken for appendicitis. It happens when a fertilized egg implants itself in a fallopian tube, rather than the uterus. This can be a medical emergency.
If your doctor suspects you might have an ectopic pregnancy, they may perform a pregnancy test. To conduct this test, they will collect a sample of your urine or blood. They may also use a transvaginal ultrasound to learn where the fertilized egg has implanted.
If you’re female, your symptoms might be caused by pelvic inflammatory disease, an ovarian cyst, or another condition affecting your reproductive organs.
To examine your reproductive organs, your doctor may perform a pelvic exam.
During this exam, they will visually inspect your vagina, vulva, and cervix. They will also manually inspect your uterus and ovaries. They may collect a sample of tissue for testing.
Abdominal imaging tests
To check for inflammation of your appendix, your doctor might order imaging tests of your abdomen. This can also help them identify other potential causes of your symptoms, such as an abdominal abscess or fecal impaction.
Your doctor may order one or more of the following imaging tests:
- abdominal ultrasound
- abdominal X-ray
- abdominal CT scan
- abdominal MRI scan
In some cases, you might need to stop eating food for a period of time before your test. Your doctor can help you learn how to prepare for it.
Chest imaging tests
Pneumonia in the lower right lobe of your lungs can also cause symptoms similar to appendicitis.
If your doctor thinks you might have pneumonia, they will likely order a chest X-ray. They may also order a CT scan to create detailed images of your lungs.
Around half of all patients with appendicitis do not have typical symptoms, and this can make it hard to diagnose. For example, the pain is not always located in the right lower quadrant of the abdomen.
Additionally, other conditions may have similar symptoms, such as:
- urinary tract infection
- ectopic pregnancy
- Crohn’s disease
- kidney stones
Not everybody’s appendix is in the same place. Sometimes it is located behind the colon, behind the liver, or in the pelvis.
A doctor will examine the patient and ask some questions related to their symptoms. They may apply pressure to the area to see if it worsens the pain.
If the doctor detects typical signs and symptoms, they will diagnose appendicitis. If not, further tests will be ordered.
Tests may include:
- blood tests, to check for infection
- an MRI, CT, or ultrasound scan, to see if the appendix is inflamed
- urine tests, to identify a kidney or bladder infection
Researchers at the Proteomics Center at Children’s Hospital in Boston, MA, have demonstrated that a protein detectable in urine could be useful as a biomarker for appendicitis.
Sometimes, a doctor will decide to surgically remove the appendix because it is too risky to wait for tests to confirm the diagnosis.
Risk factors for appendicitis
Appendicitis can affect anyone. But some people may be more likely to develop this condition than others. For example, risk factors for appendicitis include:
- Age: Appendicitis most often affects people between the ages of 15 and 30 years old.
- Sex: Appendicitis is more common in males than females.
- Family history: People who have a family history of appendicitis are at heightened risk of developing it.
Although more research is needed, low-fiber diets might also raise the risk of appendicitis.
Treatment options for appendicitis
Depending on your condition, your doctor’s recommended treatment plan for appendicitis may include one or more of the following:
- surgery to remove your appendix
- needle drainage or surgery to drain an abscess
- pain relievers
- IV fluids
- liquid diet
In rare cases, appendicitis may get better without surgery. But in most cases, you will need surgery to remove your appendix. This is known as an appendectomy.
If you have an abscess that hasn’t ruptured, your doctor may treat the abscess before you undergo surgery. To start, they will give you antibiotics. Then they will use a needle to drain the abscess of pus.
How does the surgeon remove the appendix?
The surgeon will perform a procedure called a laparoscopic appendectomy to remove the appendix. A pediatric anesthesiologist will put your child to sleep using general anesthesia. The procedure takes about 30 minutes, though CHOC’s pediatric general surgeons can remove the organ in less than 10 minutes if needed.
During surgery, three tiny incisions are made on the abdomen. Carbon dioxide is blown into the belly to create a dome, giving the surgeon room to work. Small surgical tools are inserted in two of the incisions and a laparoscopic camera is inserted in the third. The appendix is identified, stapled or tied off, and removed.
The surgeon closes the incisions with surgical glue and dissolvable strips. In most cases, children will stay in the hospital for one day before the doctor discharges them. They should have no heavy activity or sports for two weeks after surgery and can usually return to school quickly, often even the next day.
What do you do with the appendix after you take it out?
Pathologists then inspect the removed appendix in the pathology department under a microscope. This inspection is important because it will confirm the diagnosis of appendicitis and rule out other conditions such as ulcerative colitis, Crohn’s disease and carcinoid. Your surgeon will update you with the results during your follow-up appointment.
What if my appendix bursts?
“Fortunately, perforated appendicitis is less common than non-perforated appendicitis, but it can happen,” Dr. Yu says. “For some, the appendix can burst quickly, and for others it does not burst at all. There are many factors that a surgeon will consider before deciding whether to operate immediately, or to wait.”
If your surgeon decides to wait, then treatment can include antibiotics, placement of a drain in the abdomen, and nutrition through an IV if needed. Most patients improve in several days, after which the doctor discharges them. Your surgeon will then schedule your child for an interval appendectomy, which is removal of the appendix 8-12 weeks later. This gives the body time to recover from the infection and inflammation, making surgery safer and less complicated.
A physician or a general surgeon is usually the one who is first consulted for appendicitis. Emergency Room admissions are very common due to the severe pain associated with the condition.
In what age group do you frequently see the occurrence of appendicitis?
Appendicitis is frequently observed between the ages of 10 and 30 years.
What is the misdiagnosis rate of appendicitis?
The misdiagnosis rate is 12%-30%.
What is false-negative appendectomy?
Diagnosing appendicitis even though the condition is not appendicitis, is called false-negative appendectomy.
Does diet prevent appendicitis?
To date, there is no evidence that diet can prevent or treat appendicitis.
What is stump appendectomy?
This is a rare complication of appendectomy when there is inflammation in the remaining appendix following the surgery.
What does the appendix do?
The appendix is a small, finger-like projection that sticks out of the large intestine, located in the right side of the abdomen. It weighs about as much as an earthworm. In fact, its old-fashioned name is vermiform appendix, which means worm-like, Dr. Yu explains.
Everyone’s appendix is different. Some are long, some are short and stubby. But one thing they all have in common is that they are not necessary for a happy, healthy life.
“We are not sure if the appendix has a purpose. Some doctors don’t believe it does anything,” Dr. Yu says. “Some think it plays a role in the development of the immune system, and some believe it harbors ‘good bacteria’ that helps intestinal health. The bottom line, though, is that appendicitis is common, and patients do extremely well after removal of their appendix.”
What causes appendicitis?
Bacteria naturally live in the large intestine and flow in and out of the appendix. Sometimes, the opening to the appendix gets blocked. Either constipation, a hard piece of stool called a “fecalith,” or enlarged lymph nodes cause these blockages.
The blockage traps the bacteria inside where it festers and multiplies. This leads to inflammation of the organ. If left untreated, the appendix can burst, releasing the infectious bacteria into the body.
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