Appendicitis is a condition in which the appendix becomes swollen, inflamed, and filled with pus. The appendix is a small pouch shaped like a small finger. It is on the right side of the abdomen, connected to the colon.
Experts are not sure what the appendix is for. Charles Darwin wondered whether it might have been an organ our ancestors used to digest plants. Recent studies indicate that the appendix may be a dedicated environment for friendly bacteria which facilitate digestion and fight infection.
Appendicitis generally affects people aged between 10 and 30, but it can strike at any age. Approximately 250,000 appendectomies are performed in the United States each year to treat appendicitis.
Anatomy of the appendix and large intestine
The appendix is a thin, tube-shaped sac measuring about four inches long. It is normally situated on the right side of the abdomen and opens into the lower part of the large intestine.
What causes appendicitis?
Experts believe there are two likely causes of appendicitis:
- Infection - a stomach infection may have found its way to the appendix.
- Obstruction - a hard piece of stool may have got trapped in the appendix. The bacteria in the trapped stool may then have infected the appendix.
Symptoms of appendicitis
Initially, some pain can be felt anywhere in the stomach area, but later, as it intensifies, its location becomes more defined in the lower right-hand side of the abdomen - an area known as McBurney point.
The following symptoms are common:
If you experience a progressively worsening pain in your abdomen then you should seek medical attention.
- Progressively worsening pain
- Coughing or sneezing is painful
- Inability to pass gas (break wind, fart)
- Loss of appetite.
Anybody who experiences a progressively worsening pain in the abdomen should seek medical attention. Other conditions may have similar symptoms, such as urinary tract infection; even so, they all require urgent medical attention.
Diagnosing appendicitis can be challenging. Half of all patients who have appendicitis do not have typical symptoms - the pain may be located in different parts of the body. Other conditions may have very similar symptoms, such as gastroenteritis, urinary tract infection, ectopic pregnancy, Crohn's disease, or a kidney stone.
Not everybody has their appendix in exactly the same place - some are located behind the colon, behind the liver, or in the pelvis.
A GP (general practitioner, primary care physician) will examine the patient and ask some questions related to symptoms. He/she will apply pressure to the area to see if it worsens the pain.
If typical appendicitis signs and symptoms are detected, the GP will diagnose appendicitis. If they are not, further tests will be ordered. Tests may include:
A blood test - to determine whether there is an infection.
A urine test - this will identify a kidney or bladder infection. Researchers at the Proteomics Center at Children's Hospital Boston, USA, demonstrated that a protein detectable in urine might serve as a biomarker for appendicitis.
An MRI, CT or ultrasound scan - to view a 3-D image of the appendix and see whether it is inflamed (swollen). Color Doppler ultrasound, not CT, should be the first imaging examination for adult patients with suspected acute appendicitis, say researchers at Rambam Health Care Campus in Haifa, Israel.
Sometimes a decision will be made to surgically remove the appendix because it is too risky to wait around for the tests to confirm the diagnosis.
Recent developments on appendicitis from MNT news
A randomized controlled trial has brought into question the established medical doctrine that appendicitis should be treated by surgical removal, finding that a level of success can alternatively be achieved by use of antibiotics.
Managing uncomplicated appendicitis in children with antibiotics instead of an operation is an effective strategy, as long as it is chosen by the parents, says a report in JAMA Surgery. It also incurs less illness and lower costs.
On the next page we look at the treatments for appendicitis, the possible complications and how you can reduce your chances of getting appendicitis.