Appendicitis is an inflammation of the appendix that occurs most often in people between the ages of 10 and 30. It is considered a medical emergency, and treatment often involves surgery to remove the appendix. If treatment is delayed, the appendix can burst, causing infection and even death. Possible symptoms of an inflamed appendix include abdominal pain, fever, and constipation.
The appendix is a narrow tubular pouch attached to the intestines. When the appendix is blocked, it becomes inflamed and results in a condition termed 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).
The American Journal of Epidemiology study found that appendicitis was a common condition affecting approximately 6.7% to 8.6% of the population. IN the U.S. 250,000 cases of appendicitis are reported annually. Individuals of any age may be affected, with the highest incidence occurring in the teens and twenties; however, rare cases of neonatal and prenatal appendicitis have been reported. 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.
When there is a blockage inside the appendix, a person may develop appendicitis. Causes of the appendix blockage can include feces, bacterial or viral infection in the digestive tract, traumatic injury, or genetics. If the blockage is not treated quickly, the appendix could rupture.
The inflammation can be caused by a blockage of the inside of the appendix, known as the lumen. Common causes of blockage include:
Feces
Infections that lead to swelling
Trauma.
In most cases, feces will cause a blockage inside of the appendix. However, a bacterial or viral infection in the digestive tract can lead to swelling of the lymph nodes, which squeezes the appendix and causes obstruction. This is known as lymphoid hyperplasia. In rare cases, traumatic injury to the abdomen, or even genetics, may also cause blockage inside of the appendix.
A blockage of the inside of the appendix leads to increased pressure, impaired blood flow, and inflammation. Gangrene and rupture (breaking or tearing) of the appendix can result if the appendix blockage is not treated in a timely manner.
Common signs of appendicitis include abdominal pain, nausea, loss of appetite, and vomiting. However, less than 50 percent of people with the condition experience symptoms. In addition, symptoms may be different or hard to diagnose in children, pregnant women, and the elderly. What's more, these symptoms can be caused by other medical conditions, which is why people who experience possible signs of appendicitis should see their doctor immediately. Only a doctor can properly diagnose and treat the problem.
Typically, early appendicitis symptoms may include:
Pain in the abdomen, first around the belly button, and then moving to the lower-right area
Nausea
Fever of 38ºC (100.4ºF) or more
Feeling sick
Vomiting.
However, less than 50 percent of people who have appendicitis will have early symptoms of appendicitis.
Other common symptoms include:
Pain that intensifies when moving, taking deep breaths, coughing, or sneezing
Loss of appetite
Constipation or diarrhea
Inability to pass gas
Low fever that begins after other symptoms
Abdominal swelling
Feeling like a bowel movement will relieve the discomfort.
These symptoms can also be caused by other medical conditions, which is why people who experience possible symptoms of appendicitis should see their doctor immediately. Only a doctor can diagnose and treat the problem.
Many women who develop the condition during pregnancy do not experience the common appendicitis signs. Pregnant women who experience pain on the right side of their abdomen should contact a doctor immediately. Women who are in their third trimester are at a higher risk of appendicitis.
Because they generally cannot communicate their symptoms with their parents or doctors, infants and young children are usually more difficult to diagnose with appendicitis. Without a clear explanation of symptoms, doctors must rely on a physical exam and less specific symptoms, such as vomiting and fatigue. While toddlers with appendicitis may have trouble eating and may seem unusually sleepy, children with appendicitis may have constipation or small stools that contain mucus. Although signs of appendicitis vary widely among children, parents should contact a doctor immediately if they think that their child has appendicitis.
Many older adults with signs of appendicitis don't know that they have a serious problem until their appendix is close to rupturing. The elderly often experience less fever and less severe abdominal pain than other patients who have the condition. Older patients should call a doctor immediately if they are experiencing a slight fever and pain on the right side of their abdomen.
Patients with certain medical conditions may not experience the common appendicitis signs. These conditions may include:
HIV or AIDS
Obesity
Organ transplants
Diabetes
The use of immunosuppressive therapies, such as steroids
Cancer (or the use of chemotherapy).
If you're experiencing abdominal pain that's gradually getting worse, contact your doctor or cal 911 immediately.
Appendicitis can easily be confused with something else, such as bladder or urine infections, Crohn's disease, gastritis, intestinal infection and ovary problems. However, all conditions that cause constant stomach pain require urgent medical attention.
You should call 911 for an ambulance if you get a pain that suddenly becomes worse and spreads across your abdomen. These are signs that your appendix may have burst.
If the appendix bursts, it will release bacteria, which can cause serious infections, such as swelling of the inner lining of the abdomen (peritonitis) and blood poisoning.
Once a diagnosis of appendicitis is confirmed, the necessary treatment is usually surgery. In some cases, if the diagnosis is uncertain, the doctor may prescribe antibiotics as treatment if he or she is unsure whether the symptoms are being caused by appendicitis or something else, such as an infection.
There is no home care for appendicitis. If appendicitis is suspected, contact a health care practitioner 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 rupture of the appendix or mask the symptoms, which makes diagnosis more difficult.
Appendectomy can be performed as open surgery using one abdominal incision that's about 2 to 4 inches (5 to 10 centimeters) long. Or appendicitis surgery can be done as a laparoscopic operation, which involves a few small abdominal incisions. During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix.
In general, laparoscopic surgery allows you to recover faster and heal with less scarring. But laparoscopic surgery isn't appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or if an abscess is present, you may require an open appendectomy. An open appendectomy allows your surgeon to clean the abdominal cavity.
Expect to spend one or two days in the hospital after your appendectomy.
Recovery from an appendectomy takes a few weeks. Doctors usually prescribe pain medication and ask patients to limit physical activity. Recovery from laparoscopic appendectomy is generally faster, but limiting strenuous activity may still be necessary for 4 to 6 weeks after surgery. Most people who are treated for appendicitis recover excellently and rarely need to make any changes in their diet, exercise, or lifestyle.
If your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin and into the abscess. Appendectomy can be performed several weeks later after the infection is under control.
In some cases, infections may cause the same symptoms as appendicitis. Therefore, if an appendicitis diagnosis is uncertain, people may be watched and sometimes receive antibiotics. If the cause of the pain is an infection, symptoms should resolve with intravenous antibiotics and intravenous fluids. However, if the patient has appendicitis, the condition cannot be treated with antibiotics alone and will require surgery.
Occasionally, the body is able to control an appendiceal perforation (a hole) by forming an abscess. An abscess occurs when an infection is walled off in one part of the body. The doctor may choose to drain the abscess (as part of appendicitis treatment) and leave the drain in the abscess cavity for several weeks. An appendectomy may be scheduled after the abscess is drained.
Expect a few weeks of recovery from an appendectomy. If your appendix burst, it may take longer to recover. During this recovery time, you can take steps to help your body heal, such as:
Avoid strenuous activity at first. If your appendectomy was done laparoscopically, limit your activity for the first three to five days after surgery. If you had an open appendectomy, limit your activity for the first 10 to 14 days after surgery. Ask your doctor when you can go back to your normal activity.
Support your abdomen when you cough. You may feel abdominal pain when you cough, laugh or make other movements. Place a pillow over your abdomen and apply pressure before these movements to brace yourself.
Call your doctor if your pain medications aren't helping. Being in pain puts extra stress on your body and slows the healing process. If you're still in pain despite your pain medications, call your doctor.
Get up and move when you're ready. Start slowly and increase your activity as you feel up to it. Start with short walks.
Sleep when you feel tired. As your body heals, you may find you feel sleepier than usual. Take it easy and rest when you need to.
Discuss returning to work or school with your doctor. You can return to work when you feel up to it. Children may be able to return to school less than a week after surgery, though strenuous activity, such as gym class or sports, should be limited for two to four weeks after surgery.
If appendicitis is not treated, the appendix can burst and cause potentially life-threatening infections.
If your appendix bursts, it releases pus to other parts of the body, which can cause an infection in the abdomen called peritonitis.
Peritonitis is the painful swelling of the abdomen area around the stomach and liver. The condition causes your normal bowel movements to stop and your bowel to become blocked.
This causes:
severe abdominal pain
a fever of 38ºC (100.4ºF) or more
a rapid heartbeat
If peritonitis is not treated immediately it can cause long-term problems and may even be fatal.
Sometimes an abscess forms around a burst appendix. An abscess is a painful collection of pus that results from the body's attempt to fight an infection.
Abscesses can be treated using antibiotics, but in some cases the pus may need to be drained from the abscess.