Appendicitis

Overview

Appendicitis is an inflammation of the appendix. The appendix is a finger-shaped pouch that sticks out from the colon on the lower right side of the belly, also called the abdomen.

Appendicitis causes pain in the lower right part of the belly. However, in most people, pain begins around the belly button and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes serious.

Although anyone can develop appendicitis, most often it happens in people between the ages of 10 and 30. Treatment of appendicitis is usually antibiotics and, in most instances, surgery to remove the appendix.

Symptoms

Symptoms of appendicitis may include:

• Sudden pain that begins on the right side of the lower belly.
• Sudden pain that begins around the belly button and often shifts to the lower right belly.
• 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.
• Belly bloating.
• Gas.

The site of the pain may vary, depending on age and the position of the appendix. In pregnancy, the pain may seem to come from the upper belly because the appendix is higher during pregnancy.

When to see a doctor

Make an appointment with a healthcare professional if you or your child has symptoms. Terrible belly pain requires immediate medical attention.

Causes

A blockage in the lining of the appendix, called the lumen, is the likely cause of appendicitis. This blockage can cause an infection. The bacteria then multiply quickly, causing the appendix to become inflamed, swollen and filled with pus. If not treated right away, the appendix may burst or break open.

Risk factors

Risk factors for appendicitis include:

• Age. Anyone can develop appendicitis, but it most often happens in people between the ages of 10 and 30.
• Your sex. Men have a slightly higher risk of appendicitis than do women.

Complications

Appendicitis may cause serious complications, such as:

• A burst appendix. A burst appendix, also called ruptured appendix, spreads infection throughout the abdomen, a condition called peritonitis. Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean the abdominal cavity.

• A pocket of pus that forms in the abdomen. If the appendix bursts, a pocket of infection may develop. This is called an abscess. 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 prescribed to clear the infection.

  Once the infection is clear, the appendix can be removed surgically. In some people, the abscess is drained, and the appendix is removed immediately.

Diagnosis

To help diagnose appendicitis, a healthcare professional will likely take a history of symptoms and examine the abdomen.

Tests used to diagnose appendicitis include:

• Physical exam. A healthcare professional may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse. This is because of inflammation of the lining of the abdominal cavity, called the peritoneum.

  A care professional also may look for abdominal stiffness and a tendency to flex the abdominal muscles in response to pressure over the inflamed appendix. This is called guarding.

  A care professional also may use a lubricated, gloved finger to examine the lower rectum. This is called a digital rectal exam. People of childbearing age may be given a pelvic exam to check for other problems that could be causing the pain.

• Blood test. This test checks for a high white blood cell count. A high white blood cell count may mean there's an infection.
• Urine test. A urine test, also called a urinalysis, may be done. A urinalysis makes sure that a urinary tract infection or a kidney stone isn't causing the pain.
• Imaging tests. Imaging tests may help confirm appendicitis or find other causes for pain. These tests may include an abdominal X-ray, an abdominal ultrasound, a CT scan or an MRI.

Treatment

Appendicitis treatment usually involves surgery to remove the appendix. Before surgery, antibiotics to treat infection may be given.

Surgery to remove the appendix

Appendectomy is a surgery to remove the appendix. Appendectomy can be performed as open surgery using one abdominal cut about 2 to 4 inches long. This is called laparotomy. The surgery also can be done through a few small abdominal cuts. This is called laparoscopic surgery. During a laparoscopic appendectomy, the surgeon places special 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 pain and scarring. It may be better for older adults and people with obesity.

But laparoscopic surgery isn't right for everyone. You may need an open appendectomy if your appendix has ruptured and infection has spread beyond the appendix, or you have an abscess. An open appendectomy allows your surgeon to clean the abdominal cavity.

Expect to spend 1 to 2 days in the hospital after your appendectomy.

Draining an abscess before appendix surgery

If your appendix has burst and an abscess has formed around it, the abscess may be drained. To drain it, a tube is placed through your skin into the abscess. Appendectomy can be performed several weeks later, after the infection is under control.

If your appendicitis isn't serious and doesn't require surgery, antibiotics may be used alone. However, if the appendix isn't removed, there is a higher chance of appendicitis coming back.

Lifestyle and home remedies

Expect a few weeks of recovery from an appendectomy — or longer if your appendix burst. To help your body heal:

• Limit your activity. If your appendectomy was done laparoscopically, limit your activity for 3 to 5 days. If you had an open appendectomy, limit your activity for 10 to 14 days. Always ask your healthcare team about limits on your activity and when you can resume your typical activities after surgery.
• Support your abdomen when you cough. To help reduce pain, place a pillow over your belly and apply pressure before you cough, laugh or move.
• Contact your healthcare team if your pain medicines aren't helping. Being in pain puts extra stress on your body and slows the healing process. If you're still in pain despite taking your pain medicines, call a member of your healthcare team.
• Get up and move when you're ready. Start slowly and increase your activity as you feel able. Begin with short walks.
• Sleep when tired. As your body heals, you may find that you feel more tired than usual. Take it easy and rest when you need to.
• Discuss returning to work or school with your healthcare team. You can return to work when you feel ready. Children may be able to return to school less than a week after surgery. They should wait 2 to 4 weeks to return to certain activities, such as gym classes or sports.

Alternative medicine

You will be prescribed medicines to help you control pain after your appendectomy. Other treatments, when used with your medicines, can help control pain. Ask your healthcare team about safe options, such as:

• Distracting activities, such as listening to music and talking with friends, that take your mind off your pain. Distraction can be especially effective with children.
• Practicing meditation to help calm the body. Also be sure to get plenty of rest.

Preparing for an appointment

Make an appointment with a member of your healthcare team if you have abdominal pain. If you have appendicitis, you'll likely be hospitalized and referred to a surgeon to remove your appendix.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:

• Your symptoms, including any that might not seem related to the reason for your appointment.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medicines, vitamins or other supplements you take and the doses.
• Questions to ask your healthcare team.

Take a family member or friend along, if possible, to help you remember the information you're given.

For appendicitis, some basic questions to ask include:

• Do I have appendicitis?
• Will I need more tests?
• What else could I have besides appendicitis?
• Do I need surgery and, if so, how soon?
• What are the risks of appendix removal?
• How long will I need to stay in the hospital after surgery?
• How long will recovery take?
• How soon after surgery can I go back to work?
• Can you tell whether my appendix has burst?

Don't hesitate to ask other questions.

What to expect from your doctor

You are likely to be asked several questions, such as:

• When did your abdominal pain begin?
• Where does it hurt?
• Has the pain moved?
• How bad is your pain?
• What makes your pain more severe?
• What helps relieve your pain?
• Do you have a fever?
• Do you feel nauseated?
• What other symptoms do you have?