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Appendicitis

Definition

Appendicitis is swelling (inflammation) of the appendix. The appendix is a small pouch attached to the beginning of your large intestine.

Causes

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.

Symptoms

The symptoms of appendicitis can vary. It can be hard to diagnose appendicitis in young children, the elderly, and women of childbearing age.

The first symptom is often pain around your belly button. The pain may be minor at first, but it becomes more sharp and severe. Your appetite will be reduced, and you may have nausea, vomiting, and a low fever.

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 most often occurs 12 to 24 hours after the illness starts.

If your appendix breaks open (ruptures), you may have less pain for a short time and you may feel better. However, once the lining of your abdominal cavity becomes swollen and infected (a condition called peritonitis), the pain gets worse and you become sicker.

Your pain may be worse when you walk or cough. You may prefer to lie still because sudden movement causes pain.

Later symptoms include:

• Chills
• Constipation
• Diarrhea
• Fever
• Nausea
• Shaking
• Vomiting

Exams and 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

In some cases, other tests may be needed, including:

• Abdominal CT scan
• Abdominal ultrasound

Treatment

If you do not have complications, a surgeon will usually remove your appendix soon after your doctor thinks you might have the condition. For information on this type of surgery, see: Appendectomy.

Because the tests used to diagnose appendicitis are not perfect, sometimes the operation will show that your appendix is normal. In that case, the surgeon will remove your appendix and explore the rest of your abdomen for other causes of your pain.

If a CT scan shows that you have an abscess from a ruptured appendix, you may be treated for infection. You will have your appendix removed after the infection and swelling have gone away.

Outlook (Prognosis)

If your appendix is removed before it ruptures, you will likely get well very soon after surgery. If your appendix ruptures before surgery, you will probably recover more slowly, and are more likely to develop an abscess or other complications.

Possible 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

When to Contact a Medical Professional

Call your health care provider if you have abdominal pain in the lower-right portion of your belly, or any other symptoms of appendicitis. Also call your doctor if:

• Your pain is severe, sudden, or sharp
• You have a fever along with your pain
• You are vomiting blood or have bloody diarrhea
• You have a hard abdomen that is tender to touch
• You are unable to pass stool, especially if you are also vomiting
• You have chest, neck, or shoulder pain
• You are dizzy or light-headed
• You have nausea and a lack of appetite with your pain
• You are losing weight that you did not mean to lose
• You have yellowing of your eyes or skin
• You have bloating for more than 2 days
• You have 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)
• You have had abdominal pain for more than 1 week
• You have burning with urination or you are urinating more often than usual
• You have pain and may be pregnant
• Your pain gets worse when you take antacids or eat something

References

Ben-David K, Sarosi GA Jr. Appendicitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 116.

Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007;298:438-451.

Krajewski S, Brown J, Phang PT, Raval M, Brown CJ. Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis. Can J Surg. 2011;54:43-53.

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