About appendicitis

What is appendicitis?

The appendix is a small, worm-like appendage attached to the colon. Appendicitis occurs when bacteria invade and infect the wall of the appendix.

  • The most common complications of appendicitis are rupture, abscess, and peritonitis.
  • The most common signs and symptoms of appendicitis are:
    • abdominal pain,
    • loss of appetite,
    • nausea and vomiting,
    • fever, and
    • abdominal tenderness.
  • Appendicitis usually is suspected on the basis of a patient's history and physical examination; however, a white blood cell count, urinalysis, abdominal X-ray, barium enema, ultrasonography, CT scan, and laparoscopy also may be helpful in diagnosis.
  • Due to the varying size and location of the appendix and the proximity of other organs to the appendix, it may be difficult to differentiate appendicitis from other abdominal and pelvic diseases.
  • The treatment for appendicitis usually is antibiotics and appendectomy (surgery to remove the appendix).
  • Complications of appendectomy include wound infection and abscess.
  • Other conditions that can mimic appendicitis include Meckel's diverticulitis, pelvic inflammatory disease (PID), inflammatory diseases of the right upper abdomen (gallbladder disease, liver disease, or perforated duodenal ulcer), right-sided diverticulitis, and kidney diseases.

What is the appendix?

The appendix is a closed-ended, narrow tube up to several inches in length that attaches to the cecum (the first part of the colon) like a worm. (The anatomical name for the appendix, vermiform appendix, means worm-like appendage.) The open central core of the appendix drains into the cecum. The inner lining of the appendix produces a small amount of mucus that flows through the open central core of the appendix and into the cecum. The wall of the appendix contains lymphatic tissue that is part of the immune system antibodies. Like the rest of the colon, the wall of the appendix also contains a layer of muscle, but the layer of muscle is poorly developed.

What is appendicitis?

Appendicitis means inflammation of the appendix. It is thought that appendicitis begins when the opening from the appendix into the cecum becomes blocked. The blockage may be due to a build-up of thick mucus within the appendix or to stool that enters the appendix from the cecum. The mucus or stool hardens, becomes rock-like, and blocks the opening. This rock is called a fecalith (literally, a rock of stool). At other times, it might be that the lymphatic tissue in the appendix swells and blocks the opening. After the blockage occurs, bacteria which normally are found within the appendix begin to invade (infect) the wall of the appendix. The body responds to the invasion by mounting an attack on the bacteria, an attack called inflammation. An alternative theory for the cause of appendicitis is an initial rupture of the appendix followed by spread of bacteria outside of the appendix. The cause of such a rupture is unclear, but it may relate to changes that occur in the lymphatic tissue that lines the wall of the appendix, for example, inflammation.

If the inflammation and infection spread through the wall of the appendix, the appendix can rupture. After rupture, infection can spread throughout the abdomen; however, it usually is confined to a small area surrounding the appendix (forming a peri-appendiceal abscess).

Sometimes, the body is successful in containing ("healing") the appendicitis without surgical treatment if the infection and accompanying inflammation do not spread throughout the abdomen. The inflammation, pain and symptoms may disappear. This is particularly true in elderly patients and when antibiotics are used. Patients then may come to the doctor long after the episode of appendicitis with a lump or a mass in the right lower abdomen that is due to the scarring that occurs during healing. This lump might raise the suspicion of cancer.

What are the symptoms for appendicitis?

Abdominal tenderness symptom was found in the appendicitis condition

Signs and symptoms of appendicitis may include:

  • Sudden Pain that begins on the right side of the lower abdomen
  • Sudden Pain that begins around your navel and often shifts to your lower right abdomen
  • Pain that worsens if you cough, walk or make other jarring movements
  • Nausea and vomiting
  • Loss of appetite
  • Low-grade Fever that may worsen as the illness progresses
  • Constipation or diarrhea
  • Abdominal bloating

The site of your Pain may vary, depending on your age and the position of your appendix. When you're pregnant, the Pain may seem to come from your upper abdomen because your appendix is higher during pregnancy.

When to see a doctor

Make an appointment with a doctor if you or your child has worrisome signs or symptoms. Severe Abdominal Pain requires immediate medical attention.

What are the causes for appendicitis?

A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture.

What are the treatments for appendicitis?

Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to treat infection.

Surgery to remove the appendix (appendectomy)

Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10 centimeters) long (laparotomy). Or the surgery can be done through a few small abdominal incisions (laparoscopic surgery). During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix.

In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for older adults and people with obesity.

But laparoscopic surgery isn't appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity.

Expect to spend one or two days in the hospital after your appendectomy.

Draining an abscess before appendix surgery

If your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin into the abscess. Appendectomy can be performed several weeks later after controlling the infection.

What are the risk factors for appendicitis?

Appendicitis can affect anyone. But some people may be more likely to develop this condition than others. Risk factors for appendicitis include:

  • Age. Appendicitis most often affects teens and people in their 20s, but it can occur at any age.
  • 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.

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