Appendicitis

Definition

Appendicitis is a condition in which the appendix, a finger-shaped projection

connected to the large intestine, becomes inflamed and its opening

blocked. It is a medical emergency.

Description

Appendicitis develops when the opening of the appendix is blocked. This

blockage can be caused by a number of different objects ranging from

intestinal parasites to fecal matter, or by an infection. As the blockage

progresses, the appendix begins to die from lack of blood flow. It is then

invaded by bacteria and forms pus. If the condition is not treated, the

appendix swells and eventually bursts, spreading the infection throughout

the abdomen. This spread of infection and inflammation to the tissues

lining the abdomen is called peritonitis and is a very dangerous condition.

The pain of appendicitis usually starts two to three days before the

appendix gets to the point of bursting. The person typically notices a

vague discomfort in the area underneath the navel. Over the next day the

pain gets worse and moves downward toward the lower right portion of

the abdomen, near the right hip. The

at this point are nausea, vomiting, low-grade fever, and loss of appetite.

Fewer than 50 percent of patients with appendicitis, however, have the

full set of classic symptoms. Children and the elderly are often misdiagnosed

because they have fewer of these symptoms. As a result, their treatment

can be delayed. The appendix ruptures before surgery in about 270

out of every 1,000 cases, and the rate of rupture is higher in children,

pregnant women, and older adults.

“classic” symptoms of appendicitis

Demographics

The National Institutes of Health (NIH) estimates that about 7 percent

of the general population in the United States will develop appendicitis at

some point in life. There are about 1.1 cases per 1,000 people each year.

The disorder is most common in people between the ages of ten and

thirty, but it can develop at any age. In a few cases, appendicitis has been

diagnosed in newborn babies. Appendicitis is equally common in persons

of all races and ethnic groups. It is slightly more common in men than in

women, however. Although appendicitis is not hereditary, it does appear

to be more common in some families.

Causes and Symptoms

The basic cause of appendicitis is inflammation of the appendix resulting

from an obstruction of some kind or an infection. The appendix can be

blocked by an overgrowth of lymphoid tissue, food wastes, small pieces

of hardened stool, worms or other parasites, foreign objects, or a cancerous

tumor. It may also become inflamed as a result of trauma or infection,

or as a complication of Crohn disease. The blocked appendix swells

up with mucus, shutting down the blood vessels that supply it with

blood. As its tissues die, bacteria from the intestine grow rapidly within

it. If the infection is not stopped by surgical removal of the organ, the

appendix will eventually burst and the bacteria inside it will spread to

other parts of the abdomen. There is no single symptom that is unique

to appendicitis, nor is there a

patients experience. The following are the most

common symptoms and the percentages of

patients who report having them:

•

navel to the right lower part of the

abdomen: 80 percent.

Pain in the abdomen moving from the

•

Nausea: 85 percent.

•

Fever: 60 percent.

•

Loss of appetite: 74 percent.

•

Diarrhea or constipation: 18 percent.

•

80 percent. About 2 percent of patients,

however, report pain in the abdomen

lasting as long as two weeks.

Symptoms lasting less than 48 hours:

•

abdomen: 23 percent.

A previous history of pain in the

Diagnosis

Diagnosis of appendicitis is tricky and complicated,

partly because there are many diseases

and disorders

pregnancy and Crohn disease

abdominal pain, fever, and vomiting; and

partly because at least half of all patients who

have appendicitis do not have the classic symptoms

of the condition. In addition, the size and

location of the appendix varies somewhat. In

some patients the appendix is located on the left side of the body rather

than the right, and in others the appendix is unusually long and extends

from the right side toward the left side. Diagnosis of appendicitis is based

on information from several different types of examinations and tests.

—particularly complications of—that cause

•

record their temperature, and perform an examination of the

abdomen. Patients with appendicitis typically feel what is called

rebound tenderness (soreness) when the doctor first presses on the

abdomen and then releases the pressure. The patient may also

stiffen the muscles of the abdomen in response to pressure; this

reaction is called guarding. In addition, the doctor may be able to

feel that the abdomen itself is rigid. Last, the doctor may move or

rotate the patient

these maneuvers.

’s right leg or hip in order to test for pain during

•

infection.

Blood test: A high white blood cell count indicates the presence of

•

tomography (CT) scans. The CT scan is the most commonly used

imaging test to diagnose appendicitis, but x-ray studies can be

useful for detecting foreign bodies or hardened stools that may

be blocking the appendix.

Imaging tests: These may include x rays, ultrasound, or computed

•

urinary tract infection, but can be abnormal if the appendix

inflammation is close to the urinary tract.

In a few cases involving women who may have a disorder of the

ovaries or the fallopian tubes, the doctor may need to perform an exploratory

type of surgery called a laparoscopy to see which organ is causing the

patient

Urine test: This test may be done to rule out kidney stones or a’s symptoms.

Treatment

In a few cases, if the doctor is not certain of the diagnosis, he or she may

prescribe a course of antibiotics to see whether the patient

caused by something other than an inflamed appendix and may not

require surgery. For most patients, however, surgery is the only cure for

appendicitis. The surgeon can perform an appendectomy (surgical

removal of the appendix) in several different ways. The oldest procedure

is called an open appendectomy. The surgeon makes an incision (cut)

between 2 and 4 inches (5.1 and 10.2 centimeters) and in length on the

lower right side of the abdomen. The appendix is removed from its location

and the area is rinsed with sterile fluid to prevent further infection.

A newer and more commonly used technique is called a laparoscopic

appendectomy. It requires much smaller incisions, only an inch (2.5 centimeters)

or so long. The surgeon inserts a laparoscope, which is an

instrument that allows the surgeon to see inside the abdomen, through

one incision, and surgical instruments to remove the appendix through

another small incision. If the surgeon finds that the infection has spread

or that there are other complications, the operation may have to be completed

as an open appendectomy. In March 2008, surgeons at a medical

center in California removed a woman

The procedure is still considered experimental but may allow female

patients to recover more rapidly.

’s appendix through her vagina.

Prognosis

Most people do very well after an appendectomy if their appendix was

removed before it ruptured. The average hospital stay is between one and

three days after surgery, but full recovery at home may take a few weeks

before the patient can return to vigorous exercise or lifting heavy objects. The

mortality rate for appendicitis in the United States is very low, between 0.2

and 0.8 percent of patients; most of these deaths are caused by complications

of peritonitis rather than by the appendectomy itself. The rate of complications

in appendicitis increases tenfold if the appendix bursts before surgery.

Prevention

There is some evidence that people from cultures whose diets have a high

level of fiber (the part of plants that is not digested) are less likely to develop

appendicitis than those whose diets are low in fiber. It is thought that

higher levels of fiber in the diet help the intestines push food along more

efficiently, thus lowering the likelihood that the appendix will become

blocked by fecal matter. Apart from increasing the amount of fiber in one

diet, however, there is no way to predict or prevent appendicitis.

’s

The Future

As of 2008, about 10 percent of patients with appendicitis were not correctly

diagnosed on their first visit to the doctor. Ongoing research may

help doctors lower the rate of missed diagnoses of appendicitis as well as

develop improved surgical instruments and techniques.

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