Appendicitis

Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen.

Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe.

Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix.

Symptoms

Signs and symptoms of appendicitis may include:

• Sudden pain that begins on the right side of the lower abdomen
• Sudden pain that begins around your navel and often shifts to your lower right abdomen
• Pain that worsens if you cough, walk or make other jarring movements
• Nausea and vomiting
• Loss of appetite
• Low-grade fever that may worsen as the illness progresses
• Constipation or diarrhea
• Abdominal bloating
• Flatulence

The site of your pain may vary, depending on your age and the position of your appendix. When you're pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy.

When to see a doctor

Make an appointment with a doctor if you or your child has worrisome signs or symptoms. Severe abdominal pain requires immediate medical attention.

Causes

A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture.

Complications

Appendicitis can cause serious complications, such as:

• A ruptured appendix. A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity.

• A pocket of pus that forms in the abdomen. If your appendix bursts, you may develop a pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for about two weeks, and you're given antibiotics to clear the infection.

  Once the infection is clear, you'll have surgery to remove the appendix. In some cases, the abscess is drained, and the appendix is removed immediately.

Diagnosis

To help diagnose appendicitis, your doctor will likely take a history of your signs and symptoms and examine your abdomen.

Tests and procedures used to diagnose appendicitis include:

• Physical exam to assess your pain. Your doctor may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed.

  Your doctor may also look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding).

  Your doctor may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of childbearing age may be given a pelvic exam to check for possible gynecological problems that could be causing the pain.

• Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection.
• Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn't causing your pain.
• Imaging tests. Your doctor may also recommend an abdominal X-ray, an abdominal ultrasound, computerized tomography (CT) scan or magnetic resonance imaging (MRI) to help confirm appendicitis or find other causes for your pain.

Treatment

Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to treat infection.

Surgery to remove the appendix (appendectomy)

Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10 centimeters) long (laparotomy). Or the surgery can be done through a few small abdominal incisions (laparoscopic surgery). 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 pain and scarring. It may be better for older adults and people with obesity.

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

Expect to spend one or two 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 by placing a tube through your skin into the abscess. Appendectomy can be performed several weeks later after controlling the infection.

Lifestyle and home remedies

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

• Avoid strenuous activity at first. If your appendectomy was done laparoscopically, limit your activity for three to five days. If you had an open appendectomy, limit your activity for 10 to 14 days. Always ask your doctor about limitations on your activity and when you can resume normal activities after surgery.
• Support your abdomen when you cough. Place a pillow over your abdomen and apply pressure before you cough, laugh or move to help reduce pain.
• 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 tired. As your body heals, you may find that 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. They should wait two to four weeks to resume strenuous activity, such as gym classes or sports.

Alternative medicine

Your doctor will prescribe medications to help you control your pain after your appendectomy. Some complementary and alternative treatments, when used with your medications, can help control pain. Ask your doctor 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.
• Guided imagery, such as closing your eyes and thinking about a favorite place.

Preparing for an appointment

Make an appointment with your family doctor 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 seem unrelated to the reason for your appointment
• Key personal information, including major stresses, recent life changes and family medical history
• All medications, vitamins or other supplements you take, including the doses
• Questions to ask your doctor

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 your doctor 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

Your doctor is likely to ask you several questions, such as:

• When did your abdominal pain begin?
• Where does it hurt?
• Has the pain moved?
• How severe 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 signs and symptoms do you have?

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