Appendicitis

The appendix is a small, tube-like structure attached to the first part of the large intestine (cecum). While its exact function is unknown, it may play a role in gut immunity. Appendicitis occurs when the appendix becomes blocked, often by stool, a foreign body, or cancer. Blockage may also result from infection, as the appendix can swell in response to any infection in the body.

When blocked, bacteria multiply inside the appendix, leading to inflammation, swelling, and pus formation. If not treated promptly, the appendix can rupture, causing a serious infection called peritonitis. This can spread throughout the abdomen and become life-threatening.

Appendicitis can affect anyone but most commonly occurs in people between ages 10 and 30. It's one of the most common causes of emergency abdominal surgery in the United States. The standard treatment is surgical removal of the appendix (appendectomy).

Appendicitis symptoms usually start suddenly and worsen over time. The classic presentation includes:

Primary Symptoms

• Abdominal pain: Usually starts as sharp abdominal pain near the belly button that moves to the lower right
• Pain location: Eventually settles in the lower abdominal pain area, specifically the right lower quadrant
• Pain characteristics: Worsens with movement, coughing, or sneezing
• Rebound tenderness: Pain worsens when pressure is released

Associated Symptoms

• Nausea and vomiting that begin after abdominal pain starts
• Decreased appetite - loss of interest in food
• Fever - usually low-grade (99-102°F)
• Stomach bloating and abdominal swelling
• Inability to pass gas
• Constipation or diarrhea

Additional Symptoms

• Burning abdominal pain in some cases
• Side pain on the right side
• Upper abdominal pain initially
• Painful urination
• Severe cramps
• Pain that improves then suddenly worsens (may indicate rupture)

Symptoms in Special Populations

Children

• May not be able to describe pain location accurately
• Often present with vomiting and fever
• May refuse to eat or play
• Irritability and lethargy

Pregnant Women

• Pain may be higher due to displaced appendix
• Symptoms may be less typical
• Diagnosis can be more challenging

Elderly

• May have minimal symptoms
• Less likely to have fever
• Higher risk of complications

Appendicitis occurs when the appendix becomes blocked. The blockage leads to increased pressure, decreased blood flow, and inflammation. Common causes include:

Blockage Causes

• Fecalith: Hardened stool that blocks the appendix opening
• Enlarged lymph tissue: Due to infection elsewhere in the body
• Foreign bodies: Seeds, parasites, or other materials
• Tumors: Rarely, benign or malignant growths
• Intestinal worms: Parasitic infections

Risk Factors

• Age: Most common between 10-30 years
• Sex: Slightly more common in males
• Family history: May have genetic component
• Low fiber diet: May increase risk
• Gastrointestinal infections: Can trigger inflammation

If appendicitis is not treated promptly, serious complications can develop:

Ruptured Appendix

• Occurs 48-72 hours after symptoms begin
• Spreads infection throughout abdomen (peritonitis)
• Life-threatening if not treated immediately
• Requires more extensive surgery and antibiotics
• Longer recovery time

Abscess Formation

• Pocket of infected pus around appendix
• May require drainage before surgery
• Can delay appendectomy
• Requires prolonged antibiotic treatment

Other Complications

• Sepsis: Body-wide infection response
• Intestinal obstruction: From scar tissue
• Wound infection: After surgery
• Infertility: Rare, from severe pelvic infection

Diagnosing appendicitis can be challenging as symptoms can mimic other conditions. Doctors use various methods:

Physical Examination

• Abdominal exam: Checking for tenderness, rigidity, and guarding
• Rebound tenderness: Pain when pressure is released
• Rovsing's sign: Pain in right lower quadrant when left side pressed
• Psoas sign: Pain when right leg extended
• Obturator sign: Pain with internal rotation of right hip
• Digital rectal exam: To check for tenderness

Laboratory Tests

• Complete blood count: Elevated white blood cells indicate infection
• C-reactive protein: Elevated in inflammation
• Urinalysis: Rule out urinary tract infection
• Pregnancy test: For women of childbearing age

Imaging Studies

• CT scan: Most accurate test, shows inflamed appendix
• Ultrasound: Preferred for children and pregnant women
• MRI: Alternative for pregnant women
• X-ray: May show signs of blockage or perforation

Scoring Systems

• Alvarado score: Based on symptoms, signs, and lab values
• Pediatric Appendicitis Score: For children
• Help determine likelihood of appendicitis

Appendicitis is typically treated as a medical emergency. The standard treatment is surgical removal of the appendix.

Surgical Treatment

Laparoscopic Appendectomy

• Minimally invasive procedure
• 3-4 small incisions
• Camera-guided surgery
• Shorter recovery time
• Less post-operative pain
• Lower infection risk

Open Appendectomy

• Traditional surgery with larger incision
• Used for complicated cases
• Necessary if appendix has burst
• Allows thorough cleaning of abdomen
• Longer recovery period

Non-Surgical Treatment

In select cases, antibiotics alone may be tried:

• Early, uncomplicated appendicitis
• Patient not suitable for surgery
• Requires close monitoring
• 30% chance of recurrence
• May still need surgery later

Pre-Operative Care

• IV fluids for hydration
• Antibiotics to prevent infection
• Pain medication
• Nothing by mouth (NPO)
• Monitoring vital signs

Warning Signs After Surgery

Contact your doctor if you experience:

• Fever over 101°F
• Increasing abdominal pain
• Redness or drainage from incisions
• Persistent vomiting
• No bowel movement for 3 days
• Signs of infection

While appendicitis cannot be completely prevented, some measures may reduce risk:

• High-fiber diet: Fruits, vegetables, and whole grains
• Stay hydrated: Helps prevent constipation
• Regular bowel movements: Avoid constipation
• Good hygiene: Reduce infection risk
• Prompt treatment: Of gastrointestinal infections

However, most cases of appendicitis occur without warning and cannot be prevented. The key is recognizing symptoms early and seeking immediate medical care.

Several conditions can cause symptoms similar to appendicitis:

• Gastroenteritis: Stomach flu with cramping and diarrhea
• Kidney stones: Can cause severe right-sided pain
• Urinary tract infection: May cause lower abdominal pain
• Ovarian cysts: In women, can cause similar pain
• Ectopic pregnancy: Medical emergency in women
• Inflammatory bowel disease: Crohn's or ulcerative colitis
• Constipation: Can cause abdominal pain
• Mesenteric lymphadenitis: Swollen lymph nodes in abdomen