Appendicitis

Summary

• Appendicitis is inflammation of the appendix
• If untreated, an inflamed appendix can burst, causing infection and even death
• Anyone with symptoms should see a doctor immediately
• Treatment entails surgical removal of the appendix

Description

The appendix is a small, hollow tube-like structure attached to the lower right side of the colon. The lumen (cavity) of the appendix opens into the colon where it is attached to the colon, and is closed at the other end. Although the appendix does not seem to serve any purpose, it can still become diseased. Appendicitis is inflammation of the appendix.

If untreated, an inflamed appendix can burst, causing infection and even death.

Cause

Appendicitis may occur after a viral infection in the digestive tract or when the appendix is blocked by trapped stool. It can also sometimes be caused by blockage of the appendix by a worm. A blockage of the appendix causes accumulation of secretions in the appendix, which can then become inflammed or infected. The inflammation can cause infection, a blood clot, or rupture of the appendix. Because of the risk of rupture, appendicitis is considered an emergency. Anyone with symptoms needs to see a doctor immediately.

Symptoms

The person experiences pain in the lower right side of the abdomen. The pain usually begins near the navel and moves down and to the right. The pain becomes worse when moving, taking deep breaths, coughing, sneezing, and being touched in the area. The pain is usually accompanied with nausea, vomiting, loss of appetite, constipation or diarrhoea. A slight abdominal swelling may also be seen. Low grade fever may begin after all the other symptoms are present.

Symptoms may take from four to 48 hours to develop. Not everyone has all the symptoms and the pain is not always as described above. This can make it difficult to diagnose. It is important that persons with symptoms of appendicitis should not take laxatives or enemas to relieve constipation because these medicines could cause the appendix to burst. People should also not take pain medicine because it can mask symptoms that the doctor needs to know about. Children and the elderly often may show only a few symptoms, such as a tender abdomen or a loss of appetite.

Prevalence

About 1 in 500 people get appendicitis each year.

Course

An inflamed appendix left unattended may proceed to a burst appendix, which is considered a medical emergency. With a burst appendix the rest of the abdominal cavity may become soiled with the colon contents. This causes widespread infection of the abdominal cavity known as peritonitis.

Risk Factors

No risk factors are known.

Diagnosis

The doctor bases an appendicitis diagnosis on symptoms, a physical exam, blood tests to check for signs of infection such as a high white blood cell count, and urine tests to rule out a urinary tract infection. Some doctors use ultrasound to see whether the appendix looks inflamed.

Treatment

Home

Seek medical assistance as soon as the abdominal pain increases, becomes continuous, or occurs on walking or urinating. Keep the patient lying down, and comfortable. An ice pack placed over the painful area may be of help. When complaining of thirst let him/her rinse their mouth with water without swallowing. Don't give any food.

Medications

No purgatives or laxatives or any over-the-counter remedies should be given before the diagnosis is confirmed.

Surgery

Treatment of appendicitis entails surgical removal of the appendix, called an appendectomy. Many doctors use a laparoscopic surgery technique for an appendectomy. This technique involves making several tiny cuts in the abdomen and inserting a miniature eye piece and surgical instruments. The surgeon then removes the appendix with the instruments, thus there is no need to make a large incision in the abdomen. However, if the appendix is difficult to remove laparoscopically, or if it has burst, a laparotomy may be necessary. (A laparotomy involves a large incision into the abdomen.)

People can live a normal life without their appendix. No changes in diet, exercise, or other lifestyle factors are necessary.

Prevention

No prevention of appendicitis is possible.

Reviewed by Dr Andrew Whitelaw, MBBCh (Witwatersrand), MSc (UCT), FCPath (Micro) (SA) Senior registrar, Department of Microbiology, University of Cape Town and Groote Schuur Hospital