Overview
Appendicitis is an inflammation of the appendix, a finger-shaped pouch that extends from the colon on the lower right side of the abdomen. It typically causes pain in the lower right abdomen, but may start around the belly button and move. Common symptoms include sudden pain in the abdomen, nausea, vomiting, loss of appetite, and a low-grade fever. If not treated promptly, appendicitis may lead to serious complications, such as a burst appendix or an abscess. Treatment usually involves antibiotics and surgery to remove the appendix.
Understanding the disease
Symptoms
The symptoms of appendicitis may include sudden pain that begins on the right side of the lower abdomen, sudden pain that begins around the navel and often shifts to the lower right abdomen, pain that worsens with coughing, walking, or making other jarring movements, nausea and vomiting, loss of appetite, low-grade fever that may rise as the illness worsens, constipation or diarrhea, and abdominal bloating or gas.
Risk Factors
The risk factors for developing appendicitis include:
- Age: Most often, appendicitis occurs in people between the ages of 10 and 30.
- Obesity: Being overweight or obese increases the risk of conditions that may lead to appendicitis, such as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.
- Recent abdominal trauma or injury: A recent blow or injury to the abdomen can increase the risk of appendicitis.
- Certain medications: Certain medications, such as methotrexate or isoniazid, can increase the risk of appendicitis.
- Family history: Having a family history of appendicitis may increase the risk of developing the condition.
- Pregnancy: Appendicitis during pregnancy may be more challenging to diagnose due to changes in the position of the appendix and the body's natural response to pain. Remember that these risk factors do not guarantee the development of appendicitis, and many people without any risk factors may still develop the condition. If you or your child experiences symptoms of appendicitis, such as sudden pain in the lower right abdomen, it is essential to seek medical attention promptly.
Development
Appendicitis develops when the appendix, a finger-shaped pouch that sticks out from the colon on the lower right side of the belly, becomes inflamed. The most common cause of appendicitis is a blockage in the lining of the appendix, which can cause an infection. Bacteria multiply quickly, leading to the appendix becoming inflamed, swollen, and filled with pus. If not treated promptly, the appendix may burst, releasing infection into the abdominal cavity. Other possible causes of appendicitis include ulcers and fistulas.
Assessment and Diagnosis
Triage
You should see a doctor if you or your child has symptoms of appendicitis, especially if the pain begins around the navel and shifts to the lower right abdomen, worsens with coughing, walking, or jarring movements, and is accompanied by nausea, vomiting, loss of appetite, low-grade fever, constipation or diarrhea, and abdominal bloating or gas. Terrible abdominal pain requires immediate medical attention.
Diagnosis
To diagnose appendicitis, your health care team will likely take a history of your symptoms and examine your abdomen. Tests used to diagnose appendicitis include a physical exam where your care team may apply gentle pressure on the painful area and look for abdominal stiffness and guarding. A blood test may be done to check for a high white blood cell count, and you may have to take a urine test to rule out other causes of your pain. Imaging tests such as an abdominal X-ray, an abdominal ultrasound, a CT scan, or an MRI may also be done to confirm appendicitis or find other causes for your pain.
Management and Treatment
Complications
The potential complications of appendicitis are:
- A burst appendix, also called ruptured appendix, which can spread infection throughout the abdomen, leading to a condition called peritonitis. This is a potentially life-threatening situation that requires immediate surgery.
- A pocket of infection, called an abscess, can form in the abdomen if the appendix bursts. In most cases, a surgeon drains the abscess by placing a tube through the abdominal wall into the abscess. The tube is left in place for about two weeks, and antibiotics are given to clear the infection. Once the infection is clear, surgery is performed to remove the appendix. In some cases, the abscess is drained, and the appendix is removed immediately.
Treatment
The treatments for appendicitis typically involve antibiotics and surgery to remove the appendix. If the appendix has burst, the treatment may also include addressing any complications such as a burst appendix, a pocket of pus that forms in the abdomen (abscess), or peritonitis (a condition caused by the spread of infection throughout the abdomen). In such cases, a surgeon may drain the abscess and administer antibiotics to clear the infection. Once the infection is under control, surgery to remove the appendix is performed.