Early Symptoms, Causes, Pain Location, Surgery, Recovery

Written by WebMD Editorial Contributors

• What Is Appendicitis?
• Where Is Your Appendix?
• What Causes Appendicitis?
• What Are the Symptoms of Appendicitis?
• How Is Appendicitis Diagnosed?
• What Is the Treatment for Appendicitis?
• What to Expect During an Appendectomy
• Appendicitis Complications
• Appendicitis Prevention
• More

Appendicitis is an inflammation of the appendix. It’s a medical emergency that almost always requires surgery as soon as possible to remove the appendix. Luckily, you can live just fine without it.

This 3 1/2-inch-long tube of tissue extends from your large intestine on the lower right side of your body. The appendix has specialized tissue that can make antibodies, but no one is completely sure what its function is.

In the U.S., 1 in 20 people will get appendicitis at some point in their lives. Although it can strike at any age, appendicitis is rare in children younger than 2. It’s most likely to affect people between the ages of 10 and 30.

Appendicitis happens when the appendix gets blocked, often by poop, a foreign body (something inside you that isn’t supposed to be there), or cancer. Blockage may also result from infection, since the appendix can swell in response to any infection in the body.

The classic symptoms of appendicitis include:

• Pain in your lower right belly or pain near your navel that moves lower. This is usually the first sign.
• Loss of appetite
• Nausea and vomiting soon after belly pain begins
• Swollen belly
• Fever of 99-102 F
• Can’t pass gas

Other less common symptoms of appendicitis include:

• Dull or sharp pain anywhere in your upper or lower belly, back, or rear end
• Painful or difficult peeing
• Vomiting before your belly pain starts
• Severe cramps
• Constipation or diarrhea with gas

If you have any of these symptoms, see a doctor right away. Timely diagnosis and treatment are important. Don’t eat, drink, or use any pain remedies, antacids, laxatives, or heating pads.

Diagnosing appendicitis can be tricky. Symptoms are often unclear or similar to those of other illnesses, including gallbladder problems, bladder or urinary tract infection, Crohn’s disease, gastritis, kidney stones, intestinal infection, and ovary problems.

These tests can help diagnose appendicitis:

• Examination of your abdomen to look for inflammation
• Urine (pee) test to rule out a urinary tract infection
• Rectal exam
• Blood test to see whether your body is fighting an infection
• CT scans
• Ultrasound

Appendicitis is almost always treated as an emergency. Surgery to remove the appendix, which is called an appendectomy, is the standard treatment for almost all cases of appendicitis.

Generally, if your doctor suspects that you have appendicitis, they will quickly remove it to avoid a rupture. If you have an abscess, you may get two procedures: one to drain the abscess of pus and fluid, and a later one to take out the appendix. But some research shows that treating acute appendicitis with antibiotics may help you avoid surgery.

Before your appendix is taken out, you’ll take antibiotics to fight infection. You’ll usually get general anesthesia, meaning you’ll be asleep for the procedure. The doctor removes your appendix through a 4-inch-long cut or with a device called a laparoscope (a thin telescope-like tool that lets them see inside your belly). This procedure is called laparoscopy. If you have peritonitis, the surgeon will also clean out your belly and drain the pus.

You can get up and move around within 12 hours after surgery. You should be able to go back to your normal routine in 2 to 3 weeks. If you had a laparoscopy, recovery is faster.

After an appendectomy, call your doctor if you have:

• Uncontrolled vomiting
• Increased belly pain
• Dizziness/feelings of faintness
• Blood in your vomit or pee
• Increased pain and redness where your doctor cut into your belly
• Fever
• Pus in the wound

Left untreated, an inflamed appendix will burst, spilling bacteria and debris into the abdominal cavity, the central part of your body that holds your liver, stomach, and intestines. This can lead to peritonitis, a serious inflammation of the abdominal cavity’s lining (the peritoneum). It can be deadly unless it is treated quickly with strong antibiotics and surgery to remove the pus.

Sometimes, an abscess forms outside an inflamed appendix. Scar tissue then “walls off” the appendix from the rest of your organs. This keeps the infection from spreading. But an abscessed appendix can tear and lead to peritonitis.

There’s no way to prevent appendicitis. But it may be less common in people who eat foods high in fiber, such as fresh fruits and vegetables.

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Early Symptoms, Causes, Pain Location, Surgery, Recovery

Written by WebMD Editorial Contributors

• What Is Appendicitis?
• Where Is Your Appendix?
• What Causes Appendicitis?
• What Are the Symptoms of Appendicitis?
• How Is Appendicitis Diagnosed?
• What Is the Treatment for Appendicitis?
• What to Expect During an Appendectomy
• Appendicitis Complications
• Appendicitis Prevention
• More

Appendicitis is an inflammation of the appendix. It’s a medical emergency that almost always requires surgery as soon as possible to remove the appendix. Luckily, you can live just fine without it.

This 3 1/2-inch-long tube of tissue extends from your large intestine on the lower right side of your body. The appendix has specialized tissue that can make antibodies, but no one is completely sure what its function is.

In the U.S., 1 in 20 people will get appendicitis at some point in their lives. Although it can strike at any age, appendicitis is rare in children younger than 2. It’s most likely to affect people between the ages of 10 and 30.

Appendicitis happens when the appendix gets blocked, often by poop, a foreign body (something inside you that isn’t supposed to be there), or cancer. Blockage may also result from infection, since the appendix can swell in response to any infection in the body.

The classic symptoms of appendicitis include:

• Pain in your lower right belly or pain near your navel that moves lower. This is usually the first sign.
• Loss of appetite
• Nausea and vomiting soon after belly pain begins
• Swollen belly
• Fever of 99-102 F
• Can’t pass gas

Other less common symptoms of appendicitis include:

• Dull or sharp pain anywhere in your upper or lower belly, back, or rear end
• Painful or difficult peeing
• Vomiting before your belly pain starts
• Severe cramps
• Constipation or diarrhea with gas

If you have any of these symptoms, see a doctor right away. Timely diagnosis and treatment are important. Don’t eat, drink, or use any pain remedies, antacids, laxatives, or heating pads.

Diagnosing appendicitis can be tricky. Symptoms are often unclear or similar to those of other illnesses, including gallbladder problems, bladder or urinary tract infection, Crohn’s disease, gastritis, kidney stones, intestinal infection, and ovary problems.

These tests can help diagnose appendicitis:

• Examination of your abdomen to look for inflammation
• Urine (pee) test to rule out a urinary tract infection
• Rectal exam
• Blood test to see whether your body is fighting an infection
• CT scans
• Ultrasound

Appendicitis is almost always treated as an emergency. Surgery to remove the appendix, which is called an appendectomy, is the standard treatment for almost all cases of appendicitis.

Generally, if your doctor suspects that you have appendicitis, they will quickly remove it to avoid a rupture. If you have an abscess, you may get two procedures: one to drain the abscess of pus and fluid, and a later one to take out the appendix. But some research shows that treating acute appendicitis with antibiotics may help you avoid surgery.

Before your appendix is taken out, you’ll take antibiotics to fight infection. You’ll usually get general anesthesia, meaning you’ll be asleep for the procedure. The doctor removes your appendix through a 4-inch-long cut or with a device called a laparoscope (a thin telescope-like tool that lets them see inside your belly). This procedure is called laparoscopy. If you have peritonitis, the surgeon will also clean out your belly and drain the pus.

You can get up and move around within 12 hours after surgery. You should be able to go back to your normal routine in 2 to 3 weeks. If you had a laparoscopy, recovery is faster.

After an appendectomy, call your doctor if you have:

• Uncontrolled vomiting
• Increased belly pain
• Dizziness/feelings of faintness
• Blood in your vomit or pee
• Increased pain and redness where your doctor cut into your belly
• Fever
• Pus in the wound

Left untreated, an inflamed appendix will burst, spilling bacteria and debris into the abdominal cavity, the central part of your body that holds your liver, stomach, and intestines. This can lead to peritonitis, a serious inflammation of the abdominal cavity’s lining (the peritoneum). It can be deadly unless it is treated quickly with strong antibiotics and surgery to remove the pus.

Sometimes, an abscess forms outside an inflamed appendix. Scar tissue then “walls off” the appendix from the rest of your organs. This keeps the infection from spreading. But an abscessed appendix can tear and lead to peritonitis.

There’s no way to prevent appendicitis. But it may be less common in people who eat foods high in fiber, such as fresh fruits and vegetables.

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Question to the doctor: how not to miss an attack of appendicitis

It would seem that everyone knows everything about appendicitis (or, in any case, they are sure that they do). However, this well-understood disease can be tricky in terms of diagnosis, and many patients have no idea “how exactly it hurts with appendicitis. ” How to understand that you need to see a doctor urgently? How not to miss an attack?

About this – Head of the Department of Abdominal Surgery of the National Medical Research Center of Surgery. A.V. Vishnevsky, Doctor of Medical Sciences, Professor Andrey Germanovich Krieger.

What increases the risk of appendicitis?

Nobody knows. Medicine is an imprecise science.

Lifestyle, stress, nutrition?..

Neither physical activity, nor psychological troubles, nor a person’s dietary preferences affect. In men and women, the incidence of the disease is almost the same (another thing is that women are more likely to suspect appendicitis, but then gynecological problems are detected).

That is, the disease has long been described and it has long been clear what to do with it, but the risk factors are still unknown?

Unknown.

Does it make sense to remove the appendix prophylactically?

No way. Any surgical intervention carries the risk of complications, and appendectomy – removal of the appendix – is far from an indifferent operation. And not as simple as it might seem. After it, always, naturally, inevitably, adhesive adhesions occur, which can lead to intestinal obstruction, the occurrence of adhesions.

In America in the 1950s and 1960s there was a wave of prophylactic appendectomy for newborns. Refused, fortunately. The practice didn’t pay off.

Does the appendix also perform certain immunological functions?

Yes, and it is also called the intestinal tonsil, because here is the lymphoid tissue, which has a certain significance in the general immunological status of a person.

What are the symptoms of acute appendicitis?

Pain in the right iliac region (on the right lower abdomen) – not intense, constant, aching, dull, not giving anywhere. It hurts and – aching, aching, aching … And it gets worse with movement.

And many people think that appendicitis is when “it hurts in the side, it hurts”…

That’s when it hurts – it’s not appendicitis. If a person feels unbearable pain in the abdomen, it is most often colic (renal, biliary) or perforation of a hollow organ (perforated ulcer). Then there are the so-called dagger pains.

It turns out that the widespread opinion that appendicitis is a sharp pain that a person cannot endure is wrong?

Completely wrong. This pain can be tolerated, so quite often people do not go to the doctor in a timely manner.

What does constant pain mean? A day, two, three, a week?

One, two, three.

Or maybe appendicitis pain behave like this: it hurt for an hour or two and passed, the next day it hurt again for an hour or two and passed?

No, it can’t. If it started, then it aches, aches and intensifies with movement.

So call an ambulance?

Of course.

But not everyone will call an ambulance if they experience pain that can be endured for a couple of hours.

That’s the problem. I already said – quite often people do not do it on time. But we must understand that acute appendicitis is a risk of peritonitis, a life-threatening condition.

How does it all start with appendicitis?

Pain occurs in the epigastrium (upper abdomen) or throughout the abdomen. Then nausea appears (vomiting may not be there or it is one or two times). After 3-5 hours, the pain moves to the right iliac region (lower abdomen on the right). And if everything develops in this way, we can talk about inflammation of the appendix (in medicine this is called pathognomonicity – a symptom characteristic of a particular disease). The usual story of the patient goes something like this: “It hurt, something twisted in the stomach, I couldn’t understand what was the matter 2-3 hours ago, but now I got up, walked and felt that now it hurts in the right lower abdomen.” Oh my dear, it’s appendicitis!

Do characteristic symptoms make diagnosis easier?

In the vast majority of cases – yes, the diagnosis of acute appendicitis is made quite simply and confidently: epigastric pain after 2 hours shifted to the right iliac region, leukocytes are elevated, temperature is 37. 2 (the so-called Kocher’s onset, Kocher’s symptom).

Why are diagnostic errors allowed in this case?

First, the clinical picture can be the same in a number of diseases. Secondly, we talked about the classic symptomatology, which, fortunately, happens in most people, when the appendix is ​​located exactly where it is most often located. But there may be anatomical variations.

What, for example?

For example, in a woman, the caecum is elongated and shifted into the small pelvis: the fallopian tube lies, and next to it, right on top of it, is the appendix. And he got inflamed. So try it, conduct a differential diagnosis between salpingitis (inflammation of the fallopian tube) and appendicitis, when it is necessary to inflame one organ, immediately the contact inflammation passes to another.

Why did women in the past, when there was no laparoscopy, often undergo unnecessary appendectomies? Pain in the right lower abdomen. Hurts? Hurts. They take it to the table. They enter the abdomen, there is no appendicitis, but there is, for example, an ectopic pregnancy. But the shoot was removed in any case.

Why, if no appendicitis was found?

When there was no laparoscopy, surgical access for suspected appendicitis was made on the right lower abdomen. For any surgeon, such a characteristic scar was evidence that the patient had already had an appendectomy. And, if the next time a person was admitted to the hospital with complaints of abdominal pain, appendicitis was immediately ruled out and looked elsewhere. Otherwise (there is a scar, but the appendix is ​​not removed), confusion could arise with serious consequences.

But does the person remember that they “removed his appendix”?

Not always.

With all the knowledge of the disease, the diagnosis is not so simple…

Of course, it is not easy. Another option: if the appendix is ​​high, next to the gallbladder, then there will be a clinic, as in acute cholecystitis. Only acute cholecystitis does not need to be urgently operated on, because the gallbladder does not perforate a day after the onset of the disease, but acute appendicitis is necessary. But, unfortunately, there are situations when acute cholecystitis is diagnosed, dynamic observation is carried out, but it turns out to be purulent appendicitis, as a result – perforation, peritonitis …

How often does this happen?

It happens. It is no coincidence that mortality in appendicitis does not decrease. It is small (0.03 percent), but is not decreasing.

This is despite the fact that instrumental research methods today are not the same as 20-30 years ago?

Yes, and the main reason is late diagnosis. A late diagnosis is either a person did not go to the doctor in time, or a diagnostic error was made.

Has the operation itself changed?

Technically, the operation to remove the appendix has not undergone any changes – this is a classic example of the so-called amputation surgery. Only now it is carried out in a more gentle way – laparoscopically.

Which side is appendicitis

Appendicitis is an acute pathology that requires immediate surgical intervention. If steps are not taken to remove the appendix from the person’s body, life-threatening complications, such as peritonitis, can occur.

Inflammation can occur at any age, but is more common in people 10-19 years of age. The appendix of the large intestine becomes inflamed. The organ affects the functioning of the immune system and helps the body fight infection.

Causes of appendicitis

The exact causes of the development of the inflammatory process are still unclear. But there are several common options:

• Imbalance of microflora – bacteria, which in a normal environment are harmless, become poisonous and cause inflammation.

• Vasospasm – causes a deterioration in tissue nutrition. Some areas die off and become a focus of infection.

• Stagnation in the intestine – feces, foreign bodies, neoplasms or parasites can close the lumen of the appendix. At the site of closure, mucus accumulates, where the microbiome begins to multiply. The narrowing and squeezing of the process disrupts the processes of blood circulation, lymph flow, which leads to a rapid progression of inflammation and necrosis of the tissues of the appendix.

A predisposing factor will be frequent constipation, which form fecal stones.

Symptoms of appendicitis

The appendix is ​​located in the lower abdomen. The first symptom is unbearable pain that appears in the navel and extends to the lower right side of the abdomen. The pain gets worse in a short time, when moving, taking a deep breath, coughing or sneezing.

Other typical symptoms:

• nausea up to vomiting

• decreased or complete lack of appetite

• constipation or conversely diarrhea

• flatulence, painful bloating

• fever, chills, symptoms of intoxication

• urge to defecate

Signs of the inflammatory process of the appendix in men and women may differ. For example, women experience nausea, vomiting, and fever. At the beginning of the development of the disease, the pain is pressing, pulling, and even not necessarily on the right side, which can be mistakenly recognized as gynecological problems.

Then the pain can become cramping, such symptoms most often occur in the evening or at night.

In men with acute inflammation, there is severe pain in the abdomen, spontaneous pulling up of the right testicle. When pulling the scrotum, there is discomfort and pain in the anus and a pronounced urge to empty the intestines.

In older people, the symptoms of appendicitis may be less pronounced: minor pain, mild nausea. At the same time, appendicitis in the elderly is often characterized by a severe course and the development of complications.

In children under 5 years of age, the symptoms of appendicitis are not as pronounced as in adults. Pain often does not have a clear localization. You can recognize appendicitis in a small child by fever, diarrhea, and the presence of plaque on the tongue.

Types of pathology

Acute appendicitis – develops rapidly, is manifested by pronounced symptoms. With inaction, pain intensifies and inflammation can lead to serious complications.

By its nature, acute appendicitis can be complicated and uncomplicated. Uncomplicated pathology, in turn, has 2 forms: catarrhal (only the mucous membrane becomes inflamed), destructive (deeper layers are affected).

Chronic is a rather rare form. In most cases, it develops as a result of acute appendicitis in the absence of treatment. Has the same symptoms, but they manifest themselves very sluggishly. There are periods of exacerbation and remission, like any chronic disease.

Chronic appendicitis is also divided into subspecies:

• Residual – a consequence of acute appendicitis, which ended in self-healing. Manifested by dull aching pain in the right iliac region.

• Recurrent – is paroxysmal in nature: from time to time there are exacerbations, followed by remission.

• Primary chronic – develops independently, without the forerunner of acute appendicitis.

Diagnosis of appendicitis

The first thing the examination of the patient begins with is the examination and collection of anamnesis. The doctor asks to tell about when the symptoms appeared and how long the discomfort lasts. This is important to understand in order to distinguish the disease from something else.

It is important to consider other factors that could cause the development of appendicitis:

• Surgical operations in the abdomen, transferred in the recent past.

• Taking medications or supplements.

• Bad habits, abuse of alcohol, drugs, etc.

Feeling the abdomen will help determine the localization and intensity of pain, its characteristics. A pelvic and rectal examination may be needed. The final diagnosis is made only after the delivery of laboratory tests. Blood and urine tests can help detect signs of inflammation or other health problems.

Imaging methods may also be required – ultrasound of the abdominal organs, CT or MRI. They will allow:

• determine the condition of the appendix and assess its integrity

• detect signs of inflammation

• assess blockage within the appendix

• identify abscess or other complications

How to treat appendicitis?

Pathology requires immediate treatment, as the process may burst and its contents will spill into the abdominal cavity and peritonitis will begin. Therefore, the only solution is to remove the appendix surgically.

An appendectomy is a surgical operation to remove the appendix. It can be done in two ways:

1. classical – abdominal surgery

2. laparoscopic, when there are no large incisions

Abdominal surgery is performed in case of a rupture of the appendix and if its contents have spilled into the abdominal cavity, and also if the rupture has caused an abscess.

Laparoscopy is considered the most modern method of removing the appendix due to various reasons: less invasiveness, faster recovery, and fewer complications.

The operation is carried out as follows:

• the surgeon makes small incisions through which access to the appendix appears

• camera is introduced with backlight

• other tools remove the process

• areas are treated to decontaminate infectious material

• the operated area is examined, sutures are applied

Appendicitis Prevention

There is no special prevention, appendicitis can happen to anyone. It is best to give up bad habits, follow proper nutrition. A sufficient content of fiber, fresh vegetables and fruits, dairy products supports normal bowel function, prevents constipation.

Also, preventive measures include the timely treatment of any infectious and inflammatory diseases, gastrointestinal pathologies and helminthic invasions.