Appendicitis

Topic Overview

What is appendicitis?

Appendicitis is one of the causes of serious belly pain. It happens when the appendix , a part of the large intestine, becomes infected and inflamed. Experts do not know what the appendix does in the body, but most of the time it does not cause problems.

About 8 out of 100 people will get appendicitis sometime during their lives. It is most common in people ages 10 to 30, but it can happen at any age.

What causes appendicitis?

It is not clear why people get appendicitis. Infection in the appendix causes appendicitis. But doctors and scientists are not sure what causes the infection. In many cases, a small object (such as a hard piece of stool) blocks the opening to the appendix. Then bacteria can grow in the appendix and cause an infection.

What are the symptoms?

The main symptom of appendicitis is belly pain. Many people feel the first pain near the belly button. Then it moves to the lower right side of the belly. But the pain can be in different parts of your belly or even on your side or back. The pain may get worse if you move, walk, or cough. You may also have a fever or feel sick to your stomach.

Sometimes the only symptom is a general feeling of not being well and a pain that is hard to describe. The pain in your belly may be different than any pain you have had before. It may be severe. Or it may not seem like a very strong pain, but you may have the feeling that something is wrong. Trust your instincts.

Because the diagnosis is not always easy to make, it is very important to see a doctor as soon as possible if you have symptoms.

In some cases, appendicitis does not cause any symptoms except for belly pain. If you have moderate belly pain that does not go away after 4 hours, call your doctor. If you have severe belly pain, call your doctor right away.

How is appendicitis diagnosed?

Your doctor will ask you questions about what symptoms you have, when they started, and what was happening before the pain began. Your doctor will press on your belly to see where the pain is. He or she will take your temperature to see if you have a fever, which is a sign of infection. You also may have blood tests to look for signs of infection.

Your doctor may not be sure whether you have appendicitis. You may need other tests, such as a CT scan or an ultrasound of your belly.

Sometimes tests can't show for certain that you have appendicitis, but your doctor may strongly suspect that you do because of your symptoms. In this case, your doctor probably will recommend you have surgery to have your appendix taken out. Most of the time, the doctor is right and the appendix is infected. During surgery your doctor may find that your appendix is normal and something else caused your pain. Your doctor will go ahead and remove your appendix. You can live just fine without it, and taking it out gets rid of any chance that it could cause problems later.

How is it treated?

The only treatment for appendicitis is surgery to remove your appendix (appendectomy). If you have appendicitis and do not have surgery in time, your appendix can burst. A burst appendix can cause serious problems. It's best to remove the appendix before it bursts.

There are different types of surgery for appendicitis. Your surgeon may operate through a large cut (incision) in your belly or use a tool called a laparoscope to remove your appendix through a few smaller incisions. Either way, you may take antibiotics before your surgery, after your surgery, or both. There are advantages and disadvantages to each type of surgery. Talk with your surgeon about which type is best for you.

If your appendix does burst, you will need antibiotics. Surgery to remove a burst appendix may be more complicated.

Symptoms

The main symptom of appendicitis is belly (abdominal) pain. The pain can feel like indigestion or like you need to have a bowel movement or pass gas. Many people feel the first pain near the belly button. Then it moves to the lower right side of the belly. But the pain can be in different parts of your belly or even on your side. The pain may get worse if you move, walk, or cough. You may also have a fever or feel sick to your stomach.

Many people who have had appendicitis say the pain is hard to describe. It may not feel like any pain you have had before. It may not even be a very bad pain, but you may feel like something is wrong. If you have moderate belly pain that does not go away after 4 hours, call your doctor. If you have severe belly pain, call your doctor right away.

You may have appendicitis if:

• You have pain in your belly. The pain may begin around your belly button.
• The pain in your belly gets stronger and moves below your belly button on your right side (the lower right quadrant ). This is the most common place to feel pain when you have appendicitis.
• The pain does not go away and gets worse when you move, walk, or cough.
• You have pain in any part of your belly or on your side.
• You feel nauseated or throw up a few times. You also may not feel like eating.
• You have constipation, back pain, a slight fever, or a swollen abdomen.

Some people do not have the symptoms listed above. Older people, children younger than 2 years, and pregnant women may not have pain in the lower right part of the belly. Other people feel pain in their side because their appendix is in a different position than normal.

Pain in the abdomen is very common.

There are also many conditions with symptoms similar to appendicitis. But because appendicitis can become serious in a short amount of time, call your doctor right away if you have any of the symptoms listed above. Treatment is much easier if the appendix has not ruptured. In most people, the appendix does not rupture until they have felt sick for at least 24 hours.

Exams and Tests

Appendicitis is diagnosed with a medical history, physical examination, lab tests, and sometimes imaging tests. Appendicitis can be difficult to diagnose, especially in children, pregnant women, and older people.

Medical history

The doctor will ask you questions about your symptoms, including the order in which your symptoms appeared and what was happening before the pain began.

Physical exam

The doctor will push on different parts of your belly to see where the pain is. The doctor will probably focus on the lower right quadrant , where most people feel pain when they have appendicitis.

The doctor may insert a gloved finger into your anus (digital rectal exam) to help identify the cause of your pain. Women may have a pelvic exam to help rule out other problems.

Lab tests

There is no specific lab test for appendicitis. But your doctor probably will do a complete blood count (CBC) to look for signs of infection.

The doctor also may do a urine test to make sure that a urinary tract infection or kidney stone is not causing the problem. A woman may have a pregnancy test to make sure she is not pregnant.

Imaging tests

A CT scan may be used when a diagnosis of appendicitis is uncertain. CT is more accurate than ultrasound in diagnosing appendicitis.

Ultrasound can be used to take pictures of the appendix. Ultrasound is used more with pregnant women who cannot have a CT scan. It also may be used with children when their symptoms are not obvious. But the appendix cannot always be seen with an ultrasound.

Treatment Overview

The only treatment for appendicitis is surgery to remove the appendix (appendectomy). The goal is to remove the appendix before it ruptures and spreads infection to the abdomen (peritonitis).

If your doctor is not sure if you have appendicitis, you may have to wait for several hours at home or in the hospital before a decision about surgery is made. Your doctor may send you home and have you come back in 6 or 8 hours to be rechecked.

Surgery to remove the appendix can be done one of two ways-laparoscopic or traditional. Experts do not agree on which surgery is best. It often depends on what your surgeon prefers. Laparoscopic surgery uses three or four small cuts or incisions and traditional appendectomy uses one larger incision. Most people feel better immediately after surgery. Some people can even go home the same day.

If your appendix has burst and there is infection in your abdomen, you may have to stay in the hospital longer. Your treatment will include intravenous (IV) fluids and antibiotics. Surgery for a burst appendix may be more complicated. If you have a burst appendix, a radiologist may place a drain in your belly to help remove some of the infection before you have surgery to remove it. In this case, the appendix will be taken out a few weeks later. After you have your appendix removed, the doctor may leave the incision (cut) open to heal from the inside to the outside. You may also have a drain placed within the wound to help drain the infection.

You will also have to stay in the hospital longer if you have health problems that get worse after surgery.

Sometimes a doctor will recommend surgery even if he or she is not sure you have appendicitis. Surgery can eliminate the chances of a ruptured appendix. If you have surgery and your appendix is normal, your appendix will still be removed so that it will not cause future problems.

Home Treatment

If you think you may have appendicitis, do not try to treat it at home. If you have moderate belly pain that does not go away after 4 hours, call your doctor. If you have severe belly pain, call your doctor right away. It may be more likely that you have appendicitis if you have:

• Pain that does not go away. The pain from appendicitis often starts in the center of the abdomen and moves to the lower right quadrant .
• A feeling that you are going to throw up. You may throw up a few times, and you may not feel like eating.

If you think appendicitis may be causing your abdominal pain:

• Seek medical treatment immediately. If you have appendicitis, it is very important to be treated right away.
• Do not take laxatives.
• Do not eat solid food. Drink small amounts of clear liquids continually to prevent dehydration.

After surgery

Most people leave the hospital 1 to 3 days after having surgery to remove the appendix. But if the appendix has ruptured and there is infection in the abdomen or other problems, it takes longer to get better. People who have laparoscopic surgery usually return to normal activities in 1 to 3 weeks. Those who have a traditional appendectomy generally return to normal activities in 3 to 4 weeks.

While you are at home recovering from an appendectomy, check your incision(s) for infection. Call your doctor if you have a fever or notice other signs of infection such as redness, swelling, pus, or pain in your lower abdomen. You should also call your doctor if you are not able to eat normal foods after 5 days.

Related Information

• Abdominal Pain, Age 11 and Younger
• Abdominal Pain, Age 12 and Older

References

Other Works Consulted

• Sarosi GA, Turnage RH (2006). Appendicitis. In M Feldman et al., eds., Sleisinger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 2599-2612. Philadelphia: Saunders.

• Simpson J, et al. (2006). Appendicitis, search date October 2005. Online version of Clinical Evidence (15): 1-7.

Credits