Appendicitis Health Article

Definition

Appendicitis is an inflammation of the appendix, which is the worm-shaped pouch attached to the cecum, the beginning of the large intestine. The appendix has no known function in the body, but it can become diseased and inflamed. Appendicitis is a medical emergency. If it is left untreated, the appendix may rupture and cause a potentially fatal infection.

Description

Appendicitis is the most common abdominal emergency in children and young adults. One person in 15 develops appendicitis in his or her lifetime. The incidence is highest among males aged 10–14 and females aged 15–19. More males than females develop appendicitis between puberty and age 25. It is rare among the elderly and in children under the age of two.

The hallmark symptom of appendicitis is increasingly severe abdominal pain. The pain of appendicitis begins in the center of the abdomen and becomes concentrated in the lower right quadrant of the abdomen. Since many different conditions can cause abdominal pain, an accurate diagnosis of appendicitis can be difficult. A timely diagnosis is important, however, because a delay can result in perforation, or rupture, of the appendix. When this happens, infected contents of the appendix spill into the abdomen, potentially causing a serious infection of the abdomen called peritonitis.

Other conditions can have similar symptoms, especially in women. These include pelvic inflammatory disease, ruptured ovarian follicles, ruptured ovarian cysts, tubal pregnancies, and endometriosis. Various forms of stomach upset and bowel inflammation may also mimic appendicitis.

The treatment for acute (sudden, severe) appendicitis is an appendectomy, surgery to remove the appendix. Because of the potential for a life-threatening ruptured appendix, persons suspected of having appendicitis are often taken to surgery before the diagnosis is certain.

Causes and symptoms

The causes of appendicitis are not well understood, but it is believed to occur as a result of one or more of these factors: an obstruction within the appendix, the development of an ulceration within the appendix, and the invasion of bacteria.

Under these conditions, bacteria may multiply within the appendix. The appendix may become swollen and filled with pus and may eventually rupture. Signs of rupture include the presence of symptoms for more than 24 hours, a fever, a high white blood cell count, and a fast heart rate. Very rarely, the inflammation and symptoms of appendicitis may disappear but recur again later.

The distinguishing symptom of appendicitis is pain beginning around or above the navel. The pain, which may be severe or only achy and uncomfortable, eventually moves into the right lower corner of the abdomen. There, it becomes more steady and more severe, and often increases with movement or coughing. The abdomen often becomes rigid and tender to the touch. Increasing rigidity and tenderness indicates an increased likelihood of perforation and peritonitis.

Loss of appetite is very common. Nausea and vomiting may occur in about half of the cases, and occasionally there may be constipation or diarrhea. The temperature may be normal or slightly elevated. The presence of a fever may indicate that the appendix has ruptured.

Diagnosis

A careful examination is the best way to diagnose appendicitis. It is often difficult, even for experienced physicians, to distinguish the symptoms of appendicitis from those of other abdominal disorders. A physician should ask questions such as where the pain is centered, whether the pain has shifted, and where the pain began. The physician should press on the abdomen to judge the location of the pain and the degree of tenderness.

The typical sequence of symptoms is present in about 50% of cases. In the other half of cases, less typical patterns may be seen, especially in pregnant women, older people, and infants. In pregnant women, appendicitis is easily masked by the frequent occurrence of mild abdominal pain and nausea from other causes. Elderly people may feel less pain and tenderness than most individuals, thereby delaying diagnosis and treatment, and leading to rupture in 30% of cases. Infants and young children often have diarrhea, vomiting, and fever in addition to pain.

While laboratory tests cannot establish the diagnosis, an increased white cell count may point to appendicitis. Urinalysis may help to rule out a urinary tract infection that can mimic appendicitis.

Persons with a diagnosis of appendicitis are usually taken immediately to surgery, where a laparotomy (surgical exploration of the abdomen) is done to confirm the diagnosis. In cases with a questionable diagnosis, other tests such as a computed tomography (CT) scan may be performed to avoid unnecessary surgery. An ultrasound examination of the abdomen may help to identify an inflamed appendix or other condition that would explain the symptoms. Abdominal x rays are not of much value, except when an appendix has ruptured.

Often, the diagnosis is not certain until an operation is completed. To avoid a ruptured appendix, surgery may be recommended without delay if the symptoms point clearly to appendicitis. If the symptoms are not clear, surgery may be postponed until they progress enough to confirm a diagnosis.

When appendicitis is strongly suspected in a woman of child-bearing age, a diagnostic laparoscopy is sometimes recommended to be sure that a gynecological problem such as a ruptured ovarian cyst is not causing the pain. In this procedure, a lighted viewing tube is inserted into the abdomen through a small incision around the navel.

A normal appendix is discovered in about 10–20% of patients who undergo laparotomy for suspected appendicitis. Sometimes the surgeon will remove a normal appendix as a safeguard against appendicitis in the future. During the surgery, another specific cause for the pain and symptoms of appendicitis is found for about 30% of these patients.