Appendicitis is an inflammation of the appendix, which is connected to the colon. In most cases, appendicitis is an acute condition, but chronic appendicitis does occur as well. Appendicitis can be serious and potentially life-threatening if left untreated.
What is Appendicitis? Causes of Appendicitis
The appendix is a thin, finger-sized pouch connected to the first part of the large intestine (cecum). The appendix is located at the right lower quadrant (RLQ) of the abdomen. The exact function of the human appendix is unknown. Some scientists believe that the appendix is a remnant from our evolutionary past (vestigial organ), while others suggest it serves as a reservoir or "safe house" for the beneficial bacteria in the gastrointestinal tract.
Appendicitis happens when the lining of the appendix is blocked or obstructed. Causes of appendicitis can be due to:
- A hardened stool got trapped
- Enlarged lymphoid follicles
- Filarial worms
When a blockage of the appendix occurs, microorganisms invade the appendix wall and multiply. Hence, the appendix becomes inflamed, swollen, and forms pus.
Signs and Symptoms of Appendicitis
Abdominal pain is the most common symptom of appendicitis, but symptoms can vary from person to person. Some common signs and symptoms of appendicitis include:
- Pain starts around the belly and radiates to the lower right side of the abdomen
- Severe pain and tenderness upon touching over the lower right side of the abdomen
- Worse pain when you cough, sneeze or move.
- Loss of appetite
- Nausea and vomiting
- Low-grade fever
- Inability to pass gas (break wind) or stool
- Distended abdomen
The symptoms of appendicitis can be confused with urological or gynecological problems. If appendicitis occurs during pregnancy, the signs of appendicitis may be mistaken for routine discomfort from pregnancy. It is because the appendix is higher during pregnancy, causing pain from the upper abdominal. Such appendicitis can lead to miscarriage if left untreated, so pregnant women should well-recognize the appendicitis symptoms. When your pain in the abdomen is progressively worsening, you should seek medical attention as soon as possible.
Types of appendicitis
Appendicitis can be acute or chronic. Both types are serious and require medical attention promptly.
Acute appendicitis occurs suddenly without warning and symptoms in 1-2 days. It is often noticeable because the symptoms are more severe and the pain would be progressively worsening
Chronic appendicitis, on the other hand, is a rare condition in which symptoms tend to be mild and last for a long time, and then disappear and reappear. It is hard to be diagnosed until acute appendicitis develops.
Risk factors of Appendicitis
Anyone can get appendicitis, though the risk is increased by the following factors:
- Age: Appendicitis is more common in people aged 10-30 years.
- Sex: Males are more likely to develop appendicitis.
- Family history: Having a family history of appendicitis increases the risk of developing appendicitis.
Complications of Appendicitis
When appendicitis is not treated promptly, the appendix runs the risks of bursting (perforation) If the appendix is burst, it can lead to serious and possibly fatal complications such as:
- Rupture and peritonitis: Inflamed appendix can cause local inflammation of the peritoneum. If the appendix ruptures and releases the pus into the abdomen, it can cause an infection inside the abdominal cavity. It is a life-threatening condition that has to be treated immediately.
- Abscess: You may develop a pocket of infectious pus (abscess) in the appendix. It may leak pus and bacteria into your abdominal cavity, which makes surgery for appendix removal more difficult.
- Sepsis: Bacteria from the ruptured appendix can enter the bloodstream and cause sepsis. It is a serious condition that causes inflammation throughout the entire body.
Diagnosis of Appendicitis
Not everyone with appendicitis would develop some typical symptoms, and not everybody’s appendix is in the same place. Consequently, the presentation of appendicitis can be mistaken for other similar conditions, such as ectopic pregnancy, gastroenteritis, urinary tract infection and kidney stones, etc. Therefore, it is important to rule out other conditions and confirm the diagnosis by performing some of the following tests:
- Physical examination: Your doctor may check for tenderness and rigidity in the lower right part of your abdomen.
- Blood test: White blood cell count is used to check for signs of infection.
- Urine test: Sometimes, symptoms of appendicitis can be mistaken for other conditions. A urine test can help rule out other possibilities, such as urinary tract infections (UTIs) and kidney stones.
- Pelvic test: Pelvic test may be done for women to rule out possible gynecological problems, such as ovarian cysts.
- Abdominal imaging tests: Some imaging tests of the abdominal, such as a CT scan, ultrasound scan or MRI can be performed to confirm a diagnosis of appendicitis.
Treatments of Appendicitis
Appendicitis is a medical emergency that most often requires a type of surgery known as appendectomy (removal of the appendix), in order to prevent serious complications from a burst appendix. You do not have to worry about losing your appendix because living without it does not cause any health problems. There are 2 ways to perform an appendectomy:
- Open surgery: Your surgeon makes an incision in the lower right side of the abdomen to remove your appendix. It is the required approach when the removal of the appendix is difficult due to severe inflammation, or if the patient had previous surgery with significant scarring in the peritoneum that renders laparoscopic surgery difficult.
- Laparoscopy: It is a minimally invasive procedure that provides faster recovery time and less pain. Your surgeon makes several small incisions in the abdomen and a special instrument with a camera (laparoscope) will be inserted. The camera will display the images inside the abdomen, allowing the surgeon to remove the appendix.
Recent evidence has suggested the use of antibiotics without operation to treat uncomplicated appendicitis. It is usually employed as conservative management for patients who are not fit for surgery under general anesthesia, and it should be used only after careful assessment by your doctor.
Prevention of Appendicitis
Unfortunately, there’s no proven way to prevent appendicitis yet. Nevertheless, a high-fiber diet is claimed to be effective in reducing the risk of appendicitis, though the reason is not clearly understood yet. In general, fiber-rich foods include raw fruits and vegetables, whole grains, beans, and bran cereal.
Recovery from Appendicitis
Since an appendix has no known functions yet, you can live a normal life without your appendix. After laparoscopic surgery, the patient can usually go home 1 to 3 days after the surgery, depending on the degree of infection and severity of appendicitis. If an open surgery was performed instead or complications (burst appendix) occur, a longer recovery time in the hospital might be needed ( usually up to a week).
It may take several weeks to fully recover and return to normal or strenuous activities. During that time, your doctor may prescribe some antibiotics to prevent an infection after surgery. Painkillers are also helpful to support your recovery process.
After your surgery, if you experience symptoms such as repeated vomiting, fever, or worsening pain, you should visit your doctor right away as it may indicate a sign of infection.
The most common warning sign of appendicitis is the pain around the belly or the lower right side of the abdomen. Other signs and symptoms include worsening pain when you cough, sneeze or move, loss of appetite, nausea and vomiting, diarrhea, low-grade fever, inability to pass gas and constipation.
This article was medically reviewed by Dr. Kam Ming Ho Philip 甘明豪醫生. Dr. Kam is a specialist in general surgery in Hong Kong who is currently practicing at the Edinburgh Orthopaedic Spine And Surgery Centre.
This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.