Appendicitis

Definition

Appendicitis is inflammation of the appendix. The appendix is a small pouch attached to your large intestine.

Causes, incidence, and risk factors

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

Symptoms

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

Typically, the first symptom is pain around your navel. (See: abdominal pain.) The pain initially may be vague, 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 the appendix ruptures, the pain may lessen briefly and you may feel better. However, once peritonitis sets in, the pain worsens and you become sicker.

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

Later symptoms include:

• Fever
• Loss of appetite
• Nausea
• Vomiting
• Constipation
• Diarrhea
• Chills and shaking

Signs and tests

With appendicitis, pain increases when the abdomen is gently pressed and then the pressure is suddenly released. If peritonitis is present, touching the abdomen may cause a spasm of the abdominal muscles. A rectal examination may identify abdominal or pelvic pain on the right side ofyour body.

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

• Abdominal ultrasound
• Abdominal CT scan
• Diagnostic laparoscopy

Note:In December 2005, the US Food and Drug Administrationrecalled a drug used during some imaging testsafter reports of life-threatening side effects and two deaths. The drug, calledNeutroSpec, is usedto help diagnose appendicitis in patientsages 5 and older who may have the condition but do notshow the usual signs and symptoms.

Treatment

For uncomplicated cases,a surgicalprocedure called anappendectomy is performed to remove the appendix soon after the diagnosis. An appendectomycan bedone as an "open" procedure, where fairly largesurgical cuts are madein your abdomen.The surgerycan also be done as a laparoscopic procedure, which uses a camera and small incisions.

Ifthe operation reveals that the appendix is normal, the surgeon will remove the appendix and explore the rest of the abdomen for other causes of your pain.

If a CT scan reveals an abscess from a ruptured appendix, the patient may be treated and the appendix removed later, after the infection and inflammation have gone away.

Expectations (prognosis)

If your appendixis treated before it ruptures, you willprobably recover rapidly from surgery.If yourappendix ruptures before surgery, you will probablyrecover more slowly, and are more likely to develop an abscess.

Complications

• Peritonitis
• Abscess
• Fistulas
• Wound infection

Calling your health care provider

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

References

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.

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