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Anatomical landmarks, front view
Anatomical landmarks, front view


Digestive system
Digestive system


Appendectomy  - series
Appendectomy - series


Definition:

Appendicitis is 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 .



Symptoms:

The symptoms of appendicitis vary. It can be hard to diagnose appendicitis in young children, the elderly, and women of childbearing age.

Typically, the first symptom is pain around your belly button. (See: Abdominal pain ) The pain may be vague at first, but becomes increasingly sharp and severe. You may have reduced appetite, nausea, vomiting, and a low-grade fever.

As the inflammation in the appendix increases, the pain tends to move into your right lower abdomen and focuses directly above the appendix at a place called McBurney's point .

If your appendix ruptures, the pain may lessen briefly and you may feel better. However, once the lining of your abdominal cavity becomes inflamed and infected (a condition called peritonitis ), the pain gets worse and you become sicker.

Your abdominal pain may be worse when walking or coughing. You may prefer to lie still because sudden movement causes pain.

Later symptoms include:

  • Chills
  • Constipation
  • Diarrhea
  • Fever
  • Loss of appetite
  • Nausea
  • Shaking
  • Vomiting


Signs and tests:

If you have appendicitis, your pain will increase when the doctor suddenly releases the pressure after gently pressing on your lower right belly area. If you have peritonitis, touching the belly area may cause a spasm of the muscles.

A rectal examination may reveal tenderness on the right side of your rectum.

Doctors can usually diagnose appendicitis by your description of the symptoms, the physical exam, and laboratory tests. In some cases, additional tests may be needed. These may include:

Note: The U.S. Food and Drug Administration recalled a drug used during some appendicitis-related imaging tests after reports of life-threatening side effects and deaths. The drug, called NeutroSpec, was used to help diagnose appendicitis in patients ages 5 and older who may have had the condition but did not show the usual signs and symptoms.



Treatment:

If you have an uncomplicated case, 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 reveal 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 and have your appendix removed after the infection and inflammation have gone away.



Support Groups:



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
  • Infection of the surgical wound
  • Peritonitis


Calling your health care provider:

Call your local emergency department or emergency medical service (such as 911) 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 rigid, 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

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

  • You have nausea and lack of appetite
  • You are unintentionally losing weight
  • 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 discomfort 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


Prevention:



References:

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.

Ebell MH. Diagnosis of appendicitis: part 1. History and physical examination. Am Fam Physician. 2008 Mar 15;77(6):828-30. Review.

Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. Am Fam Physician. 2006 Nov 1;74(9):1537-44. Review.

Prather C. Inflammatory and anatomic diseases of the intestine, peritoneum, mesentery, and omentum. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 145.

US Food and Drug Administration. FDA Issues Public Health Advisory on use of NeutroSpec, [Technetium (99m TC) Fanolesomab], Imaging Agent for Diagnosis of Appendicitis. Rockville, MD: National Press Office; December 19, 2005. Press Release P05-104.




Review Date: 7/6/2009
Reviewed By: 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.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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