Appendicitis

Appendicitis picture

Appendicitis Facts

1. The appendix is a narrow tubular finger-shaped organ attached to the intestines on the low right side of the abdomen?. When the appendix is blocked, it becomes inflamed and results in appendicitis.
2. Seek immediate medical attention for acute lower middle or right abdominal pain accompanied with vomiting or low-grade fever.
3. There are no home remedies for appendicitis. Appendicitis treatment involves removal of the appendix (appendectomy) before the organ ruptures.

The appendix is a 2- to 4-inch-long pouch-like organ situated near the junction of the small and large intestine (located in the lower right abdomen). Obstruction of the appendix causes appendicitis. If the blockage continues, the inflamed tissue becomes infected with bacteria and begins to die from a lack of blood supply, which finally results in the rupture of the appendix (perforated or ruptured appendix).

• An American Journal of Epidemiology study in 1990 found that appendicitis was a common condition affecting approximately 6.7% of females and 8.6% of males. In the U.S., 250,000 cases of appendicitis occur annually.
• Appendicitis affects individuals of any age, with the highest incidence occurring in the teens and twenties; however, there have been reports of rare cases of neonatal and prenatal appendicitis.
• Increased vigilance in recognizing and treating potential cases of appendicitis is critical in the very young and elderly, as this population has a higher rate of complications.
• Appendicitis is the most common pediatric condition requiring emergency abdominal surgery.

There is no clear cause of appendicitis. Fecal material is thought to be one possible cause of obstruction of the appendix. Bacteria, viruses, fungi, and parasites can result in infection, leading to the swelling of the tissues of the appendix wall. The various infecting organisms include Yersinia species, adenovirus, cytomegalovirus, actinomycosis, Mycobacteria species, Histoplasma species, Schistosoma species, pinworms, and Strongyloides stercoralis. Swelling of the tissue from inflammatory bowel disease such as Crohn's disease also may cause appendicitis.

Appendicitis is not a hereditary disease and is not transmittable from person to person.

Appendicitis typically begins with a vague pain in the middle of the abdomen often near the navel or "belly button" (umbilicus). The pain slowly moves to the right lower abdomen (toward the right hip) over the next 24 hours. In the classic description, abdominal pain may be accompanied by other signs and symptoms such as nausea, vomiting, lack of appetite, and fever. Fewer than half of people who develop appendicitis have all the symptoms. More commonly, people with appendicitis have any combination of these symptoms.

• Symptoms of appendicitis may take four to 48 hours to develop. During this time, a person may have varying degrees of loss of appetite, vomiting, and abdominal pain. The person may have constipation or diarrhea, or there may be no change in bowel habits.
• Early symptoms are often hard to separate from other conditions including gastroenteritis (an inflammation of the stomach and intestines). Many people admitted to the hospital for suspected appendicitis leave the hospital with a diagnosis of gastroenteritis; initially, true appendicitis is often misdiagnosed as gastroenteritis.
• Children and the elderly often have fewer symptoms, or cannot adequately describe their symptoms, which makes their diagnosis less obvious and the incidence of complications more frequent.

Call a doctor if there are acute symptoms of middle/lower or right/lower abdominal pain with fever and/or vomiting.

If symptoms of abdominal pain continue for more than four hours, an urgent medical evaluation should be performed at the doctor's office or a hospital's emergency department. Appendicitis is a life-threatening medical emergency.

Appendicitis is diagnosed by the classic symptoms of appendicitis and physical examination (the doctor's examination of the patient's abdomen). With appendicitis, deep palpation of the lower left abdominal area will produce pain in the lower abdominal quadrant on the right side (Rovsing's sign).

• Lab work: Although no blood test can confirm appendicitis, a blood sample is sent for laboratory analysis to check the white blood cell count, which is typically elevated in an individual with appendicitis. However, normal levels can be present with appendicitis, and elevated levels can be seen with other conditions. A urinalysis may be ordered to exclude urinary tract infection (or pregnancy) as the cause of the patient's symptoms.
• Imaging tests: Imaging tests are ordered when the diagnosis is not readily apparent. A CT scan of the abdomen and pelvis can assist in evaluating abdominal pain suspected of being caused by appendicitis. Ultrasound scanning is commonly used in small children to test for appendicitis to avoid exposing the child to radiation from CT scans.

Other conditions that cause abdominal pain may mimic the symptoms of appendicitis making the diagnosis more difficult. These conditions include kidney stones, urinary tract infections, hernias, gallstones and gallbladder problems, colitis, diverticulitis, and ovarian or testicular problems.

There is no home care for appendicitis. If appendicitis is suspected, contact a doctor or go to an emergency department. Avoid eating or drinking as this may complicate or delay surgery. If you are thirsty, you may rinse your mouth with water. Do not use laxatives, antibiotics, or pain medications because these may cause delay in diagnosis that increases the risk of a ruptured appendix or masks the symptoms, making diagnosis more difficult.

Appendicitis can not be treated at home. If you suspect you have appendicitis, see your doctor or go to an emergency department.

The best treatment for appendicitis is surgical removal of the appendix (appendectomy) before the appendix ruptures. While awaiting surgery, the patient will be given IV fluids to keep hydrated. The patient will not be allowed to eat or drink because doing so may cause complications with the anesthesia during surgery.

Surgery is commonly performed via laparoscopy (laparoscopic appendectomy), a minimally invasive procedure where small "keyhole" incisions are made in the abdomen and the appendix is removed with the assistance of a small camera guided by the surgeon. In some cases, it may be necessary to do an open abdominal procedure (open surgery) to remove the appendix.

Occasionally, surgery for appendicitis reveals a non-inflamed appendix (negative appendectomy), with high rates in infants, the elderly, and young women. The use of imaging studies (CT scans, ultrasounds) has reduced the negative appendectomy rate to 7% to 12%. The difficulty in making a definite diagnosis of this medical problem and the risk of missing an acutely inflamed appendix, and the patient becoming very ill due to perforation makes a certain rate of misdiagnosis inevitable. Women in particular have a high rate of negative appendectomy as ovarian and uterine problems make the diagnosis more difficult. CT scanning prior to surgery has decreased this percentage to closer to 7% to 8% in women.

After an uncomplicated appendectomy, post-operative recovery time can vary from two to six weeks. The individual may gradually resume a normal diet with restriction in physical activity for at least two to four weeks. The doctor will inspect the incision the following week to look for possible wound infection.

There is no way of predicting when appendicitis will occur or prevent it from occurring.

There are no proven risk factors for appendicitis. It has been suggested that potential risk factors may include a diet low in fiber and high in sugar, family history, and infection.

• With uncomplicated appendicitis, most people recover with no long-term complications.
• If the appendix ruptures, there is a greater risk of complications, including infection (abscess) and death. This increase in risk generally is found in the very young, elderly, and those with weakened immune systems, including people with diabetes.
• Whether a perforated appendix is a significant risk for infertility has not been well established. Some experts recommend that this be considered in young women who might be at risk.

Stump appendicitis is a rare condition where a small amount of remaining appendix tissue from a previous appendectomy becomes inflamed. About 1/10 of 1% of patients who had appendectomy developed stump appendicitis, in one retrospective study. Symptoms are similar to the original appendicitis, with right lower quadrant pain being the most common symptom.