Appendicitis

Introduction:
Appendicitis happens when your appendix, a small finger-shaped structure that protrudes from your large intestine on the right side, gets inflamed. The inflammation is usually caused by a blockage, but may be caused by an infection. Without treatment, an inflamed appendix can rupture, causing infection of the peritoneal cavity (the lining around the abdominal organs) and even death. Appendicitis is one of the most common causes of emergency abdominal surgery. Up to 75,000 appendectomies are done each year in the U.S.

Signs and Symptoms:

The following signs and symptoms may accompany appendicitis:

Pain, starting around the navel, then moving down and to the right side of the abdomen. The pain gets worse when moving, taking deep breaths, coughing, sneezing, or being touched in this area. Loss of appetite Nausea Vomiting Change in bowel movements, including diarrhea or not being able to have a bowel movement or pass gas Low fever that starts after other symptoms Urinating often, or difficult or painful urination

What Causes It?:

Appendicitis usually happens after an infection in the digestive tract, or when the tube connecting the large intestine and appendix is blocked by trapped feces or food. Both situations cause inflammation, which can lead to infection or rupture of the appendix.

Who's Most At Risk?:

The following factors can put you at higher risk for developing appendicitis:

Family history Age -- children 2 years of age or younger and people 70 years of age or older are at higher risk for a ruptured appendix

What to Expect at Your Provider's Office:

Appendicitis is an emergency, because the appendix could rupture. If you have appendicitis symptoms, you should go to an emergency room. The doctor will ask about your symptoms and your medical history, do a physical exam to check for abdominal tenderness, and may order blood and urine tests. Some health care providers use ultrasound to check whether the appendix is inflamed (and to rule out ovarian cysts or ectopic pregnancy in women). A computed tomography (CT) scan may also be done.

Treatment Options:

Prevention
There is no proven way to prevent appendicitis. However, eating a diet that includes fresh vegetables and fruit may lower your risk of getting appendicitis.

Treatment Plan
Appendicitisis most often treated with a combination of surgery and antibiotics. Along with antibiotics, you may receive intravenous (IV) fluids and medication to control vomiting. If your doctor can' t tell from the CT scan or ultrasound whether you have appendicitis, you may have exploratory surgery. If you do have appendicitis, your appendix will be removed (appendectomy).

Drug Therapies
Your health care provider may prescribe the following medications:

Antibiotics Medications taken to ease nausea (anti-emetics)

Surgical and Other Procedures

An appendectomy is the surgical removal of the appendix through an incision in your abdomen that can be several inches long. A laparoscopic appendectomy involves making several tiny cuts in the abdomen and inserting a tiny camera and surgical instruments. The surgeon then removes the appendix through one of the small incisions. Recovery is usually faster than with traditional surgery, and the scars are smaller. However, not everyone is a candidate for a laparoscopic appendectomy.

Complementary and Alternative Therapies

Acute appendicitis is a medical emergency, and you should get conventional treatment immediately. Never try to treat appendicitis with alternative therapies alone. Some studies show that certain herbs and supplements may help to prevent appendicitis, strengthen your immune system, or help you recover faster from surgery.

Nutrition
In England and Wales, a study reviewed whether a diet that was low in fiber and high in sugar and meat had any influence on people getting appendicitis. No specific link was found with sugar or meat. But the study did suggest that the more fresh and frozen green vegetables and fresh and processed tomatoes people ate, the less likely they were to develop appendicitis. Eating green vegetables -- particularly cabbages, cauliflowers, peas, beans, and Brussels sprouts and maybe tomatoes -- may protect against appendicitis.

Herbs
Appendicitis should be treated with surgery. There are herbs that may help you recover faster from surgery; ask your doctor.

Acupuncture
In Chinese medical terms, appendicitis is thought to be caused by blockages in the circulation of blood and flow of vitality. Acupuncture may help relieve pain, control peristalsis (the wave-like movements of muscles in the intestines), and improve blood flow. A licensed and certified acupuncturist would work with your doctor to monitor your condition closely. In some parts of the world, an acupuncturist works in the hospital to deliver care at the same time as conventional medical practices. Even with surgery, acupuncture may be helpful for anesthesia, pain control, and better recovery.

Prognosis and Possible Complications:

If the appendix does not rupture, the risk of death is very low. In cases where the appendix ruptures, the death rate is higher, especially among the elderly (15%). Complications may include recurring appendicitis, inflammation of the abdominal lining, abscess (pus-filled inflamed area), sepsis (blood poisoning caused by infectious bacteria), blocking of a fallopian tube, infertility, and wound infection. Appendicitis occurs in only about 1 in 1,000 pregnancies.

Following Up:
If you have surgery, you will need to see your health care provider 2 weeks after the operation, and again at 6 weeks.

Reviewed last on: 6/15/2010 Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

Supporting Research
Ali A, Moser MA. Recent experience with laparoscopic appendectomy in a Canadian teaching centre. Can J Surg. 2008 Feb;51(1):51-5. Barker DJ, Morris J, Nelson M. Vegetable consumption and acute appendicitis in 59 areas in England and Wales. Br Med J (Clin Res Ed). 1986;292(6525):927-930. Beers MH, Porter RS, et al. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:101-102. Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, Pa: W.B. Saunders Co; 1996.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998. Feldman M, ed. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 6th ed. Philadelphia, Pa: W.B. Saunders Co; 1998. Fan YK, Zhang CC. 20 years' acupuncture in 461 acute appendicitis cases. Chin Med J (Engl). 1983;96(7):491-494. Garcia Pea BM, Mandl KD, Kraus SJ, et al. Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children. JAMA. 1999;282(11):1041-1046. Longmire WP Jr. Invited commentary. World J Surg. 1979;3(1):130-132. McKinney PE. Elemental mercury in the appendix: an unusual complication of a MexicanAmerican folk remedy. J Toxicol Clin Toxicol. 1999;37(1):103-107. No author listed Combined traditional Chinese and Western medicine in acute appendicitis. Chin Med J (Engl). 1977;3(4):266-269. Treatment of acute appendicitis in children with combined traditional Chinese and Western medicine. Chin Med J (Engl). 1977;3(6):373-378. Pisacane A, de Luca U, Impagliazzo N, Russo M, De Caprio C, Caracciolo G. Breast feeding and acute appendicitis. BMJ. 1995;310(6983):836-837. Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998;338(3):141-146. Tsai HM, Shan YS, Lin PW, Lin XZ, Chen CY. Clinical analysis of the predictive factors for recurrent appendicitis after initial nonoperative treatment of perforated appendicitis. Am J Surg. 2006 Sep;192(3):311-6. Wu HC. Treatment of acute abdominal diseases by combined traditional Chinese and Western medicine. World J Surg. 1979;3(1):91-94. Zheng XL, Chen C, Wu XZ. Acupuncture therapy in acute abdomen. Am J Chin Med. 1985;13(1-4):127-131.

Appendicitis - Overview

Overview Symptom

Symptoms:
The symptoms of appendicitis can vary. It can be hard to diagnose appendicitis in young children, the elderly, and women of childbearing age. The first symptom is often pain around your belly button. (See: Abdominal pain) The pain may be minor at first, but it becomes more sharp and severe. Your appetite will be reduced and you may have nausea, vomiting, and a low fever. As the swelling in the appendix increases, the pain tends to move into your right lower abdomen. It focuses right above the appendix at a place called McBurney's point. This most often occurs 12 to 24 hours after the illness starts. If your appendix breaks open (ruptures), you may have less pain for a short time and you may feel better. However, once the lining of your abdominal cavity becomes swollen and infected (a condition called peritonitis), the pain gets worse and you become sicker. Your pain may be worse when you walk or cough. You may prefer to lie still because sudden movement causes pain. Later symptoms include:

Chills Constipation Diarrhea Fever Nausea Shaking Vomiting

Signs and tests:

If you have appendicitis, your pain will increase when the doctor gently presses on your lower right belly area. If you have peritonitis, touching the belly area may cause a spasm of the muscles. A rectal exam may find tenderness on the right side of your rectum. Doctors can usually diagnose appendicitis by:

Your description of the symptoms The physical exam Lab tests

In some cases, other tests may be needed, including:

Abdominal CT scan Abdominal ultrasound

Treatment

Treatment:
If you do not have complications, a surgeon will usually remove your appendix soon after your doctor thinks you might have the condition. For information on this type of surgery see: Appendectomy. Because the tests used to diagnose appendicitis are not perfect, sometimes the operation will show that your appendix is normal. In that case, the surgeon will remove your appendix and explore the rest of your abdomen for other causes of your pain. If a CT scan shows that you have an abscess from a ruptured appendix, you may be treated for infection. You will have your appendix removed after the infection and swelling have gone away.

Expectations (prognosis):
If your appendix is removed before it ruptures, you will likely get well very soon after surgery. If your appendix ruptures before surgery, you will probably recover more slowly, and are more likely to develop an abscess or other complications.

Complications:

Abnormal connections between abdominal organs or between these organs and the skin surface (fistula) Abscess Blockage of the intestine Infection inside the abdomen (peritonitis) Infection of the surgical wound

Calling your health care provider:

Call your health care provider if you have abdominal pain in the lower-right portion of your belly, or any other symptoms of appendicitis. Also call your doctor if:

Your pain is severe, sudden, or sharp You have a fever along with your pain You are vomiting blood or have bloody diarrhea You have a hard abdomen that is tender to touch You are unable to pass stool, especially if you are also vomiting You have chest, neck, or shoulder pain You are dizzy or light-headed You have nausea and a lack of appetite with your pain You are losing weight that you did not mean to lose You have yellowing of your eyes or skin You have bloating for more than 2 days

You have diarrhea for more than 5 days, or your infant or child has had diarrhea for 2 days or vomiting for 12 hours (call right away if a baby younger than 3 months has diarrhea or vomiting) You have had abdominal pain for more than 1 week You have burning with urination or you are urinating more often than usual You have pain and may be pregnant Your pain gets worse when you take antacids or eat something

All Information

Definition of Appendicitis:
Appendicitis is swelling (inflammation) of the appendix. The appendix is a small pouch attached to the beginning of your large intestine.

Causes, incidence, and risk factors:

Appendicitis is one of the most common causes of emergency abdominal surgery in the United States. It usually occurs when the appendix becomes blocked by feces, a foreign object, or rarely, a tumor.

Anatomical landmarks, front view

Digestive system

Appendectomy - series

Reviewed last on: 7/22/2011 David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

References

Ben-David K, Sarosi GA Jr. Appendicitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 116. Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007 Jul 25;298(4):438-51. Review. Krajewski S, Brown J, Phang PT, Raval M, Brown CJ. Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a metaanalysis. Can J Surg. 2011;54:43-53.