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Treatment Appendicitis

Appendicitis is a painful swelling and infection of the appendix, which is a fingerlike pouch attached to the large intestine and located in the lower right area of the abdomen.

Causes

Obstruction of the appendiceal lumen causes appendicitis. Mucus backs up in the appendiceal lumen, causing bacteria that normally live inside the appendix to multiply. As a result, the appendix swells and becomes infected. Sources of obstruction include

  • feces, parasites, or growths that clog the appendiceal lumen
  • enlarged lymph tissue in the wall of the appendix, caused by infection in the gastrointestinal tract or elsewhere in the body
  • inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
  • trauma to the abdomen

An inflamed appendix will likely burst if not removed. Bursting spreads infection throughout the abdomen—a potentially dangerous condition called peritonitis.

Symptoms

Most people with appendicitis have classic symptoms that a doctor can easily identify. The main symptom of appendicitis is abdominal pain, which usually

  • occurs suddenly, often causing a person to wake up at night
  • occurs before other symptoms
  • begins near the belly button and then moves lower and to the right
  • is new and unlike any pain felt before
  • gets worse in a matter of hours
  • gets worse when moving around, taking deep breaths, coughing, or sneezing

Other symptoms of appendicitis may include

  • loss of appetite
  • nausea
  • vomiting
  • constipation or diarrhea
  • inability to pass gas
  • a low-grade fever that follows other symptoms
  • abdominal swelling
  • the feeling that passing stool will relieve discomfort

Symptoms vary and can mimic other sources of abdominal pain, including

  • intestinal obstruction
  • inflammatory bowel disease
  • pelvic inflammatory disease and other gynecological disorders
  • intestinal adhesions
  • constipation

Diagnosis

Physical Examination

Details about the abdominal pain are key to diagnosing appendicitis. The doctor will assess pain by touching or applying pressure to specific areas of the abdomen.

Responses that may indicate appendicitis include

  • Guarding. Guarding occurs when a person subconsciously tenses the abdominal muscles during an examination. Voluntary guarding occurs the moment the doctor’s hand touches the abdomen. Involuntary guarding occurs before the doctor actually makes contact.
  • Rebound tenderness. A doctor tests for rebound tenderness by applying hand pressure to a patient’s abdomen and then letting go. Pain felt upon the release of the pressure indicates rebound tenderness. A person may also experience rebound tenderness as pain when the abdomen is jarred—for example, when a person bumps into something or goes over a bump in a car.
  • Rovsing’s sign. A doctor tests for Rovsing’s sign by applying hand pressure to the lower left side of the abdomen. Pain felt on the lower right side of the abdomen upon the release of pressure on the left side indicates the presence of Rovsing’s sign.
  • Psoas sign. The right psoas muscle runs over the pelvis near the appendix. Flexing this muscle will cause abdominal pain if the appendix is inflamed. A doctor can check for the psoas sign by applying resistance to the right knee as the patient tries to lift the right thigh while lying down.
  • Obturator sign. The right obturator muscle also runs near the appendix. A doctor tests for the obturator sign by asking the patient to lie down with the right leg bent at the knee. Moving the bent knee left and right requires flexing the obturator muscle and will cause abdominal pain if the appendix is inflamed.

Women of childbearing age may be asked to undergo a pelvic exam to rule out gynecological conditions, which sometimes cause abdominal pain similar to appendicitis.

The doctor may also examine the rectum, which can be tender from appendicitis.

Laboratory Tests

Blood tests are used to check for signs of infection, such as a high white blood cell count. Blood tests may also show dehydration or fluid and electrolyte imbalances. Urinalysis is used to rule out a urinary tract infection. Doctors may also order a pregnancy test for women.

Imaging Tests

Computerized tomography (CT) scans, which create cross-sectional images of the body, can help diagnose appendicitis and other sources of abdominal pain. Ultrasound is sometimes used to look for signs of appendicitis, especially in people who are thin or young. An abdominal x ray is rarely helpful in diagnosing appendicitis but can be used to look for other sources of abdominal pain. Women of childbearing age should have a pregnancy test before undergoing x rays or CT scanning. Both use radiation and can be harmful to a developing fetus. Ultrasound does not use radiation and is not harmful to a fetus.

 

Source

National Digestive Diseases Information Clearinghouse, USA.