Appendicitis

The appendix is a narrow tubular pouch that is attached to the intestines. When the appendix is blocked, it becomes inflamed and results in the condition known as appendicitis. If the blockage continues, the inflamed tissue becomes infected with bacteria and begins to die from a lack of blood supply, which finally results in the appendix bursting.

Appendicitis is a common condition that affects 6% of the population sometime during their lifetimes. Although it most commonly occurs among those between the ages of 10-30 years, it can occur at any age. Increased vigilance is required for the very young and old because these people have a higher rate of complications.

There is no clear cause of appendicitis. Fecal material has been thought to be one possible obstructing object.

Appendicitis typically begins with a vague pain in the middle of the abdomen. The pain slowly moves to the right lower abdomen over 24 hours. In the classic description, abdominal pain is accompanied with nausea, vomiting, lack of appetite, and fever. These symptoms, however, occur in fewer than half of people who develop appendicitis. Any combination of these symptoms may or may not occur. More commonly, people with appendicitis do not have typical symptoms.

• The symptoms of appendicitis may take 4-48 hours to develop. During this time, someone developing this condition may have varying degrees of loss of appetite, vomiting, and abdominal pain. Some with developing appendicitis may have constipation, diarrhea, or no change in bowel habits.

• Early symptoms are often hard to separate from other conditions including gastroenteritis (an inflammation of the stomach and intestines). Many people admitted to the hospital for suspected appendicitis leave the hospital with a diagnosis of gastroenteritis. On the other hand, true appendicitis is often diagnosed as gastroenteritis at first.

• Children and the elderly often have fewer symptoms, which makes their diagnosis less obvious.

Call the doctor if there are acute symptoms of abdominal pain, fever, or vomiting.

If the symptoms of abdominal pain continue for more than 4 hours, then an urgent medical evaluation should be done at the doctor's office or the hospital’s emergency department.

• Lab work: Although no blood test can confirm you have appendicitis, a blood sample is sent for laboratory analysis to check the white cell count, which is typically high for someone with the condition. However, normal levels are often present with appendicitis, and elevated levels can be seen with other conditions. A urine test may be performed to exclude urinary tract infection as the cause.

• Imaging tests: In the past, diagnosis often included plain x-rays and barium enema. Some medical centers use CT scanning of the abdomen to help evaluate abdominal pain suspected of being caused by appendicitis. Ultrasound scanning is currently the most commonly used test to see the appendix.

|Self-Care at Home|

There is no home care for appendicitis. If the condition is suspected, avoid eating or drinking excessive fluids because this may complicate surgery later on. If you are thirsty, you may rinse your mouth with water. Do not take (or give your child) laxatives, antibiotics, or pain medications because they may cause rupture of the appendix or mask the symptoms, which would make diagnosis more difficult.

|Surgery|

The best treatment for appendicitis requires surgery to remove the appendix (the operation is called an appendectomy)—before the appendix opens or ruptures. While awaiting surgery, you will be given IV fluids to keep hydrated. You will not be allowed to eat or drink because doing so may cause complications with the anesthesia during surgery.

|Follow-up|

After an uncomplicated appendectomy (surgical removal of the appendix), you may gradually resume a normal diet with a restriction in physical activity for at least 3-4 weeks. The doctor will check the incision the following week to look for possible wound infection.

|Prevention|

There is no way of predicting when appendicitis will occur. It cannot be prevented.

|Outlook|

• With uncomplicated appendicitis, most people recover with no long-term problems.

• If the appendix ruptures, there is a greater than 10 times risk of complications, including death. This increase in risk generally is found in the very young, elderly, and those with weakened immune systems, including people with diabetes.

• Whether a perforated appendix is a significant risk for infertility has not been well established. Some experts recommend this be considered in young women who might be at risk.

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Author: Britt A Durham, MD, Co-Director of Risk Management, Assistant Professor, Department of Emergency Medicine, King-Drew Trauma Center and University of California at Los Angeles.

Editors: Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Anthony Anker, MD, FAAEM, Attending Physician, Emergency Department, Mary Washington Hospital, Fredericksburg, VA.