APPENDICITIS

General Information

DEFINITION--Inflammation of the vermiform appendix, a small intestinal pouch that extends from the cecum, the first part of the large intestine. The appendix has no known function, but it can become diseased. Appendicitis affects 1 in 500 people each year. Symptoms vary widely. Appendicitis should be considered in any person with undiagnosed abdominal pain.

BODY PARTS INVOLVED--Appendix; cecum; peritoneum (membrane covering the intestinal tract).

SEX OR AGE MOST AFFECTED--All ages, but rare in children under 2. The incidence peaks between ages 15 and 24.

SIGNS & SYMPTOMS

• Pain that begins close to the navel and migrates toward the right lower abdomen. Pain becomes persistent and well-localized. It worsens with moving, breathing deeply, coughing, sneezing, walking or being touched.
• Nausea and sometimes vomiting.
• Constipation and inability to pass gas.
• Diarrhea (occasionally).
• Low fever, beginning after other symptoms.
• Tenderness in the right lower abdomen, usually about a third of the distance from the navel to the top of the hip bone. (This description applies only if the appendix is in its normal position. In some cases, the tip of the appendix is located elsewhere, making diagnosis difficult).
• Abdominal swelling (late stages).
• Increased white-blood-cell count.

CAUSES--Infection for unknown reason, usually with bacteria from the intestinal tract. The appendix may become obstructed from contents moving through intestinal tract, or by a constricting band of tissue. When infected, it becomes swollen, inflamed and filled with pus.

RISK INCREASES WITH

• Recent illness, especially a roundworm infestation or gastrointestinal virus infection or intra-abdominal tumors.
• Family tendency.

HOW TO PREVENT--No specific preventive measures.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam (maybe several) by a doctor.
• Laboratory blood studies. Tests usually show higher levels of white blood cells.
• Urinalysis to rule out a urinary-tract infection, which can mimic appendicitis.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Surgery to remove the appendix. Because appendicitis can be hard to diagnose, surgery is often withheld until symptoms and signs progress enough to confirm the diagnosis.

> Misdiagnosis because of few or atypical symptoms--especially in the very young or very old.

PROBABLE OUTCOME--Usually curable with surgery. If totally untreated, a ruptured appendix can be fatal.

How To Treat

GENERAL MEASURES--

• While diagnosis is uncertain, take a rectal temperature every 2 hours. Keep a record for your doctor.
• For an explanation of surgery and postoperative care, see Appendectomy in Surgery section.

MEDICATION--

• Don't take any laxatives, enemas or medicines for pain. Laxatives may cause rupture, and pain or fever reducers make diagnosis more difficult.
• Your doctor may prescribe antibiotics to reduce chance of infection, pain medicine following surgery and stool softeners to prevent constipation.

ACTIVITY--Rest in a bed or chair until surgery.

DIET--

• Don't eat or drink anything until appendicitis has been diagnosed. Anesthesia for surgery is much safer if the stomach is empty. If you are very thirsty, wash your mouth out with water.
• A liquid diet, progressing to soft diet following surgery.

Call Your Doctor If

• You have symptoms of appendicitis.
• The following occurs while surgery is pending: Fever spikes of 102F (38.9C) or over. Continued vomiting. Increased pain in the abdomen. Fainting. Blood in the stool or vomit.