Appendicitis

Overview

Appendicitis is a medical emergency where the appendix becomes clogged, infected, and inflamed, causing painful swelling. This small, tube-shaped organ attached to the large intestine usually requires immediate surgery for removal. Fortunately, living without the appendix poses no significant issues.

What is Appendicitis?

In simple terms, appendicitis is the inflammation of the appendix. The appendix is a 3.5-inch-long tissue tube that extends from your large intestine on the lower right side of your body responsible for fighting infection and hosts lymphoid cells which play a significant role for your immune system. It can cause acute (sudden, intense) pain in your lower abdomen. The appendix is a small, finger-sized tubular pouch that extends from the lower right end of the large intestine.

When appendicitis occurs, it releases bacteria from your bowels into your abdominal cavity, causing an infection called peritonitis. This infection can then enter your bloodstream, potentially leading to life-threatening complications such as sepsis.

Symptoms of Appendicitis

The most common symptoms of appendicitis include abdominal pain, nausea, and loss of appetite. Appendicitis symptoms can vary, but commonly include:

- Pain that may begin around your belly button and move to the lower right side of your abdomen or start directly in that area.
- Increasing severity of pain over time.
- Pain that worsens with movement, deep breathing, touching, coughing, or sneezing.
- Pain that may spread across your abdomen if the appendix bursts.

Additional symptoms of appendicitis may also include:

- Nausea
- Vomiting
- Loss of appetite
- Constipation or diarrhea
- Fever and a flushed face

Causes of Appendicitis

Appendicitis occurs when there is a blockage in the lining of the appendix. This blockage can cause infections as bacteria multiply quickly, leading the appendix to become inflamed, swollen, and filled with pus. It may also occur if the tube connecting the large intestine to the appendix becomes blocked by stool. Tumors can sometimes cause appendicitis as well.

Here’s how appendicitis can develop:

- Inflammation: The appendix becomes sore and swollen.
- Impaired Blood Flow: As swelling worsens, the blood supply to the appendix decreases.
- Necrosis: Insufficient blood flow causes the appendix to start dying.
- Complications: The appendix may burst or develop holes, allowing stool, mucus, and infection to leak into the abdominal cavity.

The appendix’s size and location make it prone to blockages and infections. With many bacteria present in the large intestine, an overgrowth in the appendix can lead to infection. Sometimes appendicitis starts with an infection, or the infection may be secondary to swelling that traps bacteria.

Tests and Treatment for Appendicitis

To diagnose appendicitis, you need to perform the following tests including a physical exam where pressure is applied to the painful area; if the pain worsens when the pressure is released, it can indicate appendicitis. Your healthcare provider will also review your medical history may order the following tests:

- Blood Tests
- Urine Tests

Including imaging tests:

- Abdominal Ultrasound which allows visualization of internal organs and assesses blood flow through various blood vessels.
- CT Scan which provides detailed images of the body, including bones, muscles, fat, and organs.
- MRI is used, particularly in pregnant women, as an alternative to CT scans for diagnosing appendicitis.

Appendectomy, the removal of the appendix, is the most common form of treatment used. This can be done via laparotomy, using a larger cut in the belly, or laparoscopy, which uses small cuts and a camera. Laparoscopy usually results in faster recovery, less pain, and smaller scars, making it preferable for older adults or overweight individuals. If the appendix has burst and spread infection, or if an abscess has formed, a larger cut might be necessary to clean the abdomen. After surgery, a hospital stay of 1-2 days is typically required. In some cases, if the appendix has burst but formed an abscess, doctors may first drain the abscess and later perform surgery to remove the appendix. Antibiotics might be used alone for very mild appendicitis, but there is a higher chance of recurrence if the appendix is not removed.

Prevention of Appendicitis

There are no known methods to prevent appendicitis.