Definition

The appendix is a small, tube-like organ that hangs from the large intestine. Appendicitis is inflammation of the appendix. The appendix has no known function.

Causes

Appendicitis usually occurs when the appendix becomes inflamed. This can be caused by something trapped in the appendix, such as:

• A piece of dried stool
• A piece of food
• Tumors
• Scar tissue
• Worms
• Barium after an exam
• Overgrowth of the lymph tissue of the appendix

The lining of the appendix continues to produce mucus. It has no place to go. Bacteria normally found in the intestines build up and make toxins in the lining of the appendix. Pressure builds and causes severe pain in the abdomen. The wall of the appendix can break open. The contents of a ruptured appendix can spill into the abdominal cavity. This causes serious redness and swelling. This is called peritonitis. It can be fatal.

Risk Factors

Appendicitis is more common in men and teenagers.

You are at increased risk of developing appendicitis if you have family members who have had appendicitis.

Symptoms

Symptoms usually happen quickly. Pain usually increases during a 6-12 hour period. Patients may have some or all of the following symptoms:

• Pain
  • Starts as discomfort around the belly button
  • Usually moves to the right side of the abdomen over several hours
  • May be in a different location if the appendix is not in the usual place
  • Increases as redness and swelling in the appendix builds
  • Worsens with sneezing, coughing, and deep breathing
  • May increase with movement
• Loss of appetite
• Nausea
• Vomiting
• Swelling of the abdomen
• Abdomen feels hard and is sensitive to touch
• Constipation
• Mild diarrhea
• Slight fever

If the appendix ruptures, symptoms include:

• Pain becoming stronger and spreading across the abdomen
• Increasing fever

Note: Symptoms may be different in infants, children, pregnant women, and the elderly.

Diagnosis

If you have severe pain in the abdomen, get medical help right away. Appendicitis can be hard to diagnose. Symptoms vary and can be similar to symptoms of other diseases.

You will be asked about your symptoms and medical history. A physical exam will be done, including:

• A careful examination of the abdomen
• A rectal exam

Your bodily fluids may be tested. This can be done with:

• Blood tests
• Urine tests

Your bodily structures may need to be viewed. This can be done with:

• Ultrasound
• Computed tomography (CT) scan
• Laparoscopy

Treatment

Appendicitis may be treated by surgically removing the appendix as soon as possible. Sometimes the diagnosis is not certain. Your condition will be carefully monitored for 6-12 hours before operating. You will also be given antibiotics to fight infection.

Sometimes appendicitis does not need to be treated with surgery and you will just be given antibiotics.

Prevention

There are no guidelines to prevent appendicitis. It starts quickly and the cause is usually unknown. Get medical care right away for severe abdominal pain. It will decrease the risk of rupture.

National Institute of Diabetes and Digestive and Kidney Diseases http://digestive.niddk.nih.gov

Healthy U http://www.healthyalberta.com

Appendicitis. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated October 27, 2014. Accessed December 1, 2014.

Appendicitis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
http://digestive.niddk.nih.gov/ddiseases/pubs/appendicitis/
Accessed December 1, 2014.

Diagnosis of appendicitis in emergency departments. Am Fam Physician. 2003;67:2390.

JAMA patient page: appendicitis. JAMA. 1999;282:1102.

7/13/2007 DynaMed’s Systematic Literature Surveillance
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Styrud J, Eriksson S, Nilsson I, et al. Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial. World J Surg. 2006;30:1033-1037.

5/27/2014 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
McCutcheon BA, Chang DC, et al. Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis. J Am Coll Surg. 2014 May;218(5):905-913.

6/23/2014 DynaMed’s Systematic Literature Surveillance
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Choosing wisely. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 26, 2014. Accessed December 1, 2014.