Diseases & Conditions

 

Appendicitis

Diseases & Conditions

What is appendicitis?

Appendicitis is an inflammation of the appendix which is a small tube of tissue attached to the large intestine. The role of the appendix is not fully understood and removing it from the body does not seem to affect a person’s health.

Appendicitis is one of the most common causes of abdominal pain in the world and the most common abdominal surgical emergency. Although appendicitis can happen at any age, it is mostly manifested between the ages of 10 and 20 years.1

 

What causes appendicitis?

The cause of appendicitis is considered to be a blockage or obstruction of the appendix and the subsequent onset of bacterial infection.2 The bacteria multiply rapidly causing the appendix to become swollen and infected. The obstruction of the appendix can be produced by various mechanisms:

  • Stool or parasites that block the appendix
  • Infection of the gastrointestinal tract causing an enlarged lymph tissue in the wall of the appendix
  • Inflammatory bowel disease and other long-term disorders that cause irritations and ulcers in the gastrointestinal tract
  • Trauma to the abdomen

 

What are the symptoms of appendicitis?

The classic symptoms of appendicitis include:3

  • Abdominal pain: This is the most common symptom of appendicitis that occurs suddenly and before any other symptoms. It begins near the navel and spreads to the lower right of the abdomen. Abdominal pain may worsen after couple of hours.
  • Nausea
  • Vomiting
  • Loss of appetite
  • Constipation or diarrhea
  • Fever
  • Abdominal swelling

 

How is appendicitis diagnosed?

Diagnosis of acute appendicitis relies on a thorough history and examination:4

Medical history:

Abdominal pain is the primary presenting complaint of patients with appendicitis. The doctor will ask questions about the history of the abdominal pain, the exact location and severity of the pain and other symptoms.

 Physical examination:

Physical examination is the most useful method for diagnosing appendicitis and for determining whether an operation is necessary. The doctor will assess the pain by touching or applying pressure to specific areas of the abdomen.

 Laboratory tests:

    • Blood tests: A high white blood cell count is a sign of infection.
    • Urine tests: Testing urine is important in order to exclude a urinary tract infection or a kidney stone

 Imaging tests:

    • Abdominal ultrasound
    • Abdominal X-ray
    • Computerized tomography (CT) scan

 

How is appendicitis treated?

Most of the time, a surgeon will remove the appendix as soon as the patient is diagnosed to avoid its rupture.5

  • During the surgery: The surgery is known as appendectomy and it is the standard treatment for appendicitis. First of all, the patient is given antibiotics to fight possible infections of the abdomen. Afterwards, a general anesthesia is performed allowing the surgeon to remove the appendix through a single incision in the lower right area of the abdomen.

 

  • After the surgery: Appendectomy needs a short recovery time and with adequate care, most patients recover quickly without making changes in their diet, exercise or lifestyle. Doctors recommend limiting physical activity for the first two weeks after an appendectomy.


 What are the complications and treatment of a burst appendix?

If appendicitis is not treated, the appendix can burst and the infection spreads throughout the abdomen causing potentially life-threatening infections. This condition is called peritonitis which needs immediate medical attention.6

Symptoms of peritonitis can include:

  • Severe abdominal pain
  • Extreme illness
  • A high fever
  • Rapid heartbeat
  • Shortness of breath with rapid breathing
  • Swelling of the abdomen

  

References

  1. Humes, D. J., and J. Simpson. "Acute appendicitis." British Medical Journal 7567 (2006): 530.
  2. Ishikawa, Hiroshi. "Diagnosis and treatment of acute appendicitis." JAPAN MEDICAL ASSOCIATION JOURNAL 46.5 (2003): 217-221.
  3. Symptoms and Causes of Appendicitis (Symptoms and Causes of Appendicitis) http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/appendicitis/Pages/symptoms-causes.aspx (Accessed December 13, 2015)
  4. Appendicitis (Tests and diagnosis) http://www.mayoclinic.org/diseases-conditions/appendicitis/basics/tests-diagnosis/con-20023582 (Accessed December 13, 2015)
  5. Treatment for Appendicitis (Treatment for Appendicitis) http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/appendicitis/Pages/treatment.aspx (Accessed December 13, 2015)
  6. Appendicitis - Complications (Appendicitis) http://www.nhs.uk/Conditions/Appendicitis/Pages/Complications.aspx (Accessed December 13, 2015)