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Appendicitis

Written by Verneda Lights and Elizabeth Boskey, PhD | Published on July 25, 2012
Medically Reviewed by George Krucik, MD

What is Appendicitis?

Appendicitis is inflammation of the appendix. It may be acute or chronic.

Harrison’s Principles of Internal Medicine states that appendicitis is the most common medical emergency in the United States. More than 250,000 appendectomies are performed annually.

Appendicitis occurs most often between the ages of 10 and 30. It is more common in men than in women. Untreated appendicitis can be fatal.

Anatomy of the Appendix

The appendix is a small, finger-shaped protrusion of the colon. It is found in the lower right quadrant of the abdomen. Its purpose is unknown.

What Causes Appendicitis?

Scientists think this condition is caused by an obstruction in the appendix. Obstruction may be either partial or complete. Complete obstruction is cause for emergency surgery.

Obstruction is often caused by an accumulation of fecal matter. It can also be caused by:

  • enlarged lymphoid follicles
  • worms
  • trauma
  • tumors

When the appendix is obstructed, bacteria can multiply inside the organ. This leads to the formation of pus. The increased pressure can be painful. It can also compress local blood vessels. A lack of blood flow to the appendix may cause gangrene.

If the appendix ruptures, fecal matter can fill the abdomen. This is a medical emergency.

Peritonitis is one possible consequence of a ruptured appendix. It is an inflammation of the tissue that lines the abdominal wall. Other organs can also become inflamed after a rupture. Affected organs may include the cecum, bladder, and sigmoid colon.

If the infected appendix leaks instead of ruptures, it can form an abscess. This confines the infection to a small area. However, an abscess can still be dangerous.

What Are the Symptoms of Appendicitis?

Symptoms of appendicitis include:

  • lower right side abdominal pain
  • loss of appetite
  • nausea
  • vomiting
  • diarrhea
  • constipation
  • inability to pass gas
  • abdominal swelling
  • low grade fever
  • a sense you might feel better after passing stool

Appendicitis pain may start off as mild cramping. It often becomes more steady and severe with time. You will not necessarily notice changes in your bowel habits. However, sometimes appendicitis can affect urination.

If you have right side tenderness along with any of these other symptoms, talk to a doctor. Appendicitis can quickly become a medical emergency. Rupture rarely happens within the first 24 hours of symptoms. However, up 80 percent of people who have symptoms for 48 hours will end up with a ruptured appendix.

A perforated appendix can be fatal. The risk of death is highest in infants and the elderly.

How Is Appendicitis Diagnosed?

A physical exam for appendicitis looks for tenderness in the lower right quadrant of your abdomen. If you are pregnant, the pain may be higher. If perforation occurs, your stomach may become hard and swollen.

A swollen, rigid belly is a symptom that should be discussed with a doctor right away.

In addition to looking for tenderness, your doctor will also perform several tests for appendicitis.

Urinalysis can rule out a urinary tract infection or kidney stone.

Pelvic exams can make certain that women don’t have reproductive problems. They can also rule out other pelvic infections.

Pregnancy tests can rule out a suspected ectopic pregnancy.

Abdominal imaging can determine if you have an abscess or other complications. This may be done with an X-ray, ultrasound, or CT scan.

Chest x-ray can rule out right lower-lobe pneumonia. This sometimes has symptoms like appendicitis.

How Is Appendicitis Treated?

Treatment for appendicitis varies.

In rare cases, appendicitis may get better without surgery. Treatment might involve only antibiotics and a liquid diet.

In most cases, however, surgery will be necessary. The type of surgery will depend on the details of your case.

If you have an abscess that has not ruptured, you will first be treated with antibiotics. Your abscess will then be drained with a tube placed through your skin. Surgery will remove your appendix after your infection has been treated.

If you have a ruptured abscess or appendix, surgery may be needed right away. Surgery to remove the appendix is called an appendectomy.

This procedure can be done as open surgery or laproscopically. Laparoscopy is less invasive. Recovery time is shorter. However, open surgery may be necessary if you have an abscess or peritonitis.

Is Appendicitis Preventable?

Appendicitis cannot be prevented. However, it is less common in people who have diets high in fiber. This includes diets which contain lots of fresh fruits and vegetables.

Seek medical attention immediately if you think you have appendicitis. Untreated appendicitis can become a medical emergency.

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