Appendicitis

What is appendicitis?

Appendicitis is an inflammation of the appendix. The appendix is a small, finger-shaped pouch where the large and small intestines join. Scientists are not sure what the appendix does, if anything. But when it is inflamed, it gets swollen and painful and can cause serious problems.

It is important to get treatment for appendicitis before the appendix ruptures. A rupture is a break or tear in the appendix. If an infected appendix breaks open, infection and bowel movement may spread inside the abdomen. This can cause a life-threatening infection of the belly called peritonitis.

Because of the risk of rupture, appendicitis is considered an emergency.

How does it occur?

In most cases appendicitis is caused by a blockage of the opening of the appendix by a piece of bowel movement. Sometimes it is caused by infection in the digestive tract.

What are the symptoms?

The symptoms can differ from person to person. They may include:

• pain, usually starting near the bellybutton, then moving to the right lower side of the belly
• loss of appetite
• nausea
• vomiting
• constipation or diarrhea
• trouble passing gas
• fever, usually not very high.

The symptoms of peritonitis are much more severe. The pain is worse and is felt throughout the abdomen. Your belly may be swollen and feel tight or hard. It may hurt to walk.

Children under 10 and adults over 50, as well as pregnant women, are less likely to have the usual symptoms of appendicitis. Because of this, they may not get treatment right away, which makes it more likely that the appendix will burst. They should be especially careful to report symptoms that could be early signs of appendicitis. If you have abdominal pain and fever or vomiting for more than a couple hours, call your healthcare provider.

If you think you may have appendicitis and are about to see your healthcare provider, do not eat or drink anything until you have been examined. If you have symptoms of peritonitis, you must be seen by your healthcare provider or go to the emergency room right away.

How is it diagnosed?

Sometimes it is hard to diagnose appendicitis. Your healthcare provider will ask about your symptoms and examine you. You may have the following tests:

• blood tests
• urine tests
• chest X-rays (because pneumonia in the lower right lung can also cause abdominal pain)
• X-ray, ultrasound, or CT exam of your belly.

If the diagnosis is not clear, you may be watched closely in the emergency room or hospital for 12 to 24 hours to see if surgery is needed.

If your provider does not hospitalize you and sends you home without surgery, your provider will probably ask you to:

• Not use any pain medicine. Taking pain medicine could make it hard for you to know if the pain gets better or worse.
• Not use any enemas or laxatives. These medicines increase the risk that the appendix will rupture if it is inflamed.
• Not take any antibiotics.
• Contact your provider if any of your symptoms get worse over the next few hours.
• Bring a urine sample with you when you return in 24 hours or sooner for another exam. If you are returning for another exam, do not eat or drink anything on the day of your exam, in case you have to have surgery.
• Take your temperature every 2 to 4 hours and keep a record. Bring it with you when you go back to your provider.

If your healthcare provider sends you home, call your provider if any of the following happen:

• You keep vomiting.
• The pain in your belly gets worse.
• Your fever gets higher.
• You feel lightheaded or have fainted.
• You have blood in your vomit or bowel movement.

How is it treated?

Appendicitis is usually treated with surgery to remove the appendix. It is important to have surgery to remove the appendix before it ruptures.

If the appendix has ruptured, you may have an infected sore (abscess) near the place where it ruptured. You will have a special kind of X-ray called computed tomography, or CT, to help find the abscess. Your provider may drain the abscess before surgery. To drain an abscess, you will be given a local anesthetic to numb your skin. Then your provider will make a small cut and put a drainage tube through your belly and into the abscess. The drainage tube will be left in place for about 2 weeks while you take antibiotics to treat the infection. When infection and inflammation are under control, then surgery will be done to remove what is left of the ruptured appendix.

You may need to take antibiotics for a while before and after surgery.

How long do the effects last?

Without treatment, appendicitis can be fatal. If your appendix is removed before it ruptures, you will usually feel much better in a couple of days.

If the appendix ruptured, you will stay in the hospital for several days, and you may need more than 1 surgery. Your recovery time will be much longer.

You can live a normal life without an appendix.

How can I take care of myself?

Be sure to carefully follow the treatment prescribed by your healthcare provider. If an antibiotic has been prescribed, take all of it according to your provider’s instructions. To feel better as soon as possible you should also:

• Get plenty of sleep but avoid staying in bed for long periods of time during the day. Gradually increase your walking and activity as directed by your provider.
• Take pain medicine according to your provider’s instructions.
• Eat small frequent meals. Eat foods high in protein while you are healing if your provider says it is OK.
• Keep the surgical wound clean. Wash your hands before and after changing the dressing.
• Contact your provider if the following signs of wound infection appear:
  • redness or warmth at the suture site
  • increasing pain at the wound site
  • yellow or green drainage from the wound
  • fever

Can I help prevent appendicitis?

Doctors don’t know how to prevent appendicitis. However, people who eat foods containing fiber and roughage such as raw vegetables, fruits, and whole grains seem to have a lower risk of appendicitis.