Appendicitis
Appendicitis is an inflammation of the appendix, a blind ending tube attached to the part of the bowel called the caecum.
The appendix is located on the right side of the body in the lower part of the abdomen. Although it does not seem to perform any particular function in the body, inflammation of the appendix, usually caused by a blockage of impacted stool, must be treated medically.
Left untreated, the inflamed appendix can become gangrenous and perforate causing peritonitis (a serious inflammation of the abdomen), causing the whole abdomen to become rigid. An operation to remove the infected appendix is called an appendectomy and is probably one of the most common operations performed as an emergency.
Appendicitis is most common in younger people particularly between the ages of 8 and 14 years. It is not to be confused with a 'grumbling' appendix, which refers to recurrent bouts of pain in the right lower abdomen. In only a few cases is it actually due to a problem with the appendix.
Symptoms
The 'classical picture' of appendicitis as seen in 50% of cases is:
- Abdominal pain. - This usually starts in the centre of the abdomen and is described as colicky (comes and goes in waves). Later, the pain becomes constant and settles in the lower right part of the abdomen where it may persist for hours.
- Associated loss of appetite.
- Vomiting.
- Tenderness in the lower right part of the abdomen.
- Associated fever.
- Increased heart rate.
Other Presentations
The position of the appendix may vary and therefore symptoms of appendicitis may differ slightly from person to person. For example:
- If the appendix lies near the back passage (rectum) there may be diarrhoea.
- If it lies near the bladder there may be symptoms of pain passing urine and passing urine more often.
- An inflamed appendix near the fallopian tube can cause pain in the pelvis, which may be suggestive of a gynaecological disorder.
- If appendicitis occurs during pregnancy, the pain is felt higher up in the abdomen because the appendix is displaced upwards by the enlarging womb.
Diagnosis
Appendicitis can be difficult to diagnose if the symptoms are atypical and if the appendix is not in the usual position. It is also more difficult to diagnose in the elderly and in children younger than 2 years. Furthermore, the symptoms of appendicitis, particularly pain in the right lower abdomen, are similar to those of other illnesses such as:
- Urinary tract infection
- Gynaecological problems
- Mesenteric adenitis. - (Inflammation of the lymph nodes due to a viral infection. There may be an associated sore throat.)
If your doctor suspects appendicitis he or she will examine your abdomen and carry out some tests, which may include a blood count to determine whether your white cells are elevated, kidney blood tests and urine tests.
Treatment
Appendicitis is a medical emergency. An appendectomy must be performed to surgically remove the inflammed appendix. This operation is performed in hospital under general anaesthetic. It can be done either through an incision in the right lower abdomen leaving a small scar or through keyhole (laparoscopic) surgery.
Written by Medpages Editorial Team
Last Editorial Review: 10/1/2010
