Engaging patients in high-quality, compassionate health care

Appendicitis

DESCRIPTION

Appendicitis is a swelling or inflammation of the appendix and is one of the most common causes for emergency abdominal surgery. The function of the appendix is unknown but there are no long term consequences of removing the appendix.  Appendicitis is considered a medical emergency, prompt diagnosis and surgery for removal are very important.  If left untreated, an inflamed appendix eventually will burst, or perforate, spilling infectious materials into the abdominal cavity.

In the United States, one in 15 people will get appendicitis.  Although it can occur at any age, appendicitis is rare under age 2 and most common between ages 10 and 30.

Symptoms

Appendicitis is sometimes referred to as the “Great Masquerader” because the symptoms and location of pain can vary greatly.  It can be difficult to diagnose appendicitis in young children, the elderly, and women of childbearing age.

The most common symptom of appendicitis is a dull pain near or around the belly button.  The pain may be mild at first and become sharper as it moves to the lower right abdomen. Loss of appetite and nausea or vomiting occur soon after the pain begins.  There may be fever, abdominal swelling and bloating.  It may be difficult to pass gas. As the swelling in the appendix increases, the pain tends to move into your right lower abdomen. It focuses right above the appendix at a place called McBurney’s point. This pain may occur 12 to 24 hours after the illness starts. Other symptoms may include pain anywhere in the upper or lower abdomen, back or rectum.  Pain can vary from dull to sharp.  Constipation or diarrhea with gas and cramping are also symptoms that can occur.

Common Symptoms

  • Dull pain near the navel or the upper abdomen
  • Loss of appetite
  • Nausea and vomiting soon after abdominal pain begins
  • Abdominal swelling
  • Fever of 99-102 degrees Fahrenheit
  • Inability to pass gas
  • Dull or sharp pain anywhere in the upper or lower abdomen, back, or rectum
  • Painful urination
  • Vomiting that precedes the abdominal pain
  • Severe cramps
  • Constipation or diarrhea with gas

Causes, incidence, and risk factors

Appendicitis is one of the most common causes of emergency abdominal surgery in the United States. It usually occurs when the appendix becomes blocked by feces, a foreign object, or rarely, a tumor.  There is no known prevention of appendicitis.

WORK-UP/TESTS

If you have appendicitis, your pain will increase when the doctor gently presses on your lower right belly area. If you have peritonitis, touching the belly area may cause a spasm of the muscles. A rectal exam may find tenderness on the right side of your rectum.

Doctors can usually diagnose appendicitis by:

  • Your description of the symptoms
  • The physical exam

Lab tests

  • Complete blood count may show elevated white blood count
  • Liver function tests
  • Kidney function

Diagnostic studies

TREATMENT

The treatment for appendicitis is surgical removal of the appendix as soon as possible.  The tests used to diagnose appendicitis are not perfect, sometimes the operation will show that your appendix is normal.  If this occurs, the surgeon will remove your appendix and explore the rest of your abdomen to look for other causes of your pain.

If a CT scan shows that you have an abscess (a walled off pocket of infection) from a ruptured appendix, you may be treated for infection with intravenous antibiotics before surgery. You will have your appendix removed after the infection and swelling have gone away.

EXPECTATIONS (PROGNOSIS)

If your appendix is removed before it ruptures, you will likely recover quickly after surgery.   If your appendix ruptures before surgery, your recovery may take longer.  People with compromised immune systems like diabetes may have a longer recovery process or more complications.

Complications
  • Abnormal connections between abdominal organs or between these organs and the skin surface (fistula)
  • Abscess
  • Blockage of the intestine
  • Infection inside the abdomen (peritonitis)
  • Infection of the surgical wound
  • An infection can spread to bloodstream
  • Death
When to call your healthcare provider

Call your healthcare provider if you have abdominal pain in the lower-right portion of your belly, or any other symptoms of appendicitis.

Also call your doctor for:

  • Severe, sudden or sharp pain
  • Fever along with pain
  • Vomiting blood or bloody diarrhea
  • Abdomen is hard and tender to touch
  • Inability to pass stool, especially if you are also vomiting
  • Chest, neck, or shoulder pain
  • Dizziness or light-headedness
  • Nausea and a lack of appetite with your pain
  • Yellowing of your eyes or skin
  • Bloating for more than 2 days
  • Diarrhea for more than 5 days, or your infant or child has had diarrhea for 2 days or vomiting for 12 hours (call right away if a baby younger than 3 months has diarrhea or vomiting)
  • Abdominal pain lasting more than 1 week
  • Burning with urination or frequent urination
  • Worsened pain when taking antacids or eating something

Susan Puckett, PA-C, ENT and Internal Medicine

BACK