Appendicitis is a term that describes the inflammation of the appendix, which is a lengthy piece of tissue that extends from the large intestine and is part of our digestive system. Appendicitis can occur suddenly and can be very painful. Appendicitis can develop at any time but occurs most commonly in a patient’s 20s or 30s. It’s estimated that roughly 5 percent of the US population will have appendicitis in their lifetime. If left untreated, appendicitis can be very serious and should always be treated as a medical emergency. Read on to learn more about the causes and symptoms of appendicitis and when to seek treatment if you suspect appendicitis.
What Causes Appendicitis?
The appendix, as well as appendicitis itself, is somewhat of a mystery to doctors and researchers. Not only do doctors not know what the true function of the appendix is, but they also cannot pinpoint the exact causes of appendicitis. It is believed that the main precursor to appendicitis is a blockage or obstruction near its opening. There are several reasons that the appendix could be blocked. This could be caused by:
- Traumatic injury
- Intestinal worms
- A hardened stool
- Enlarged lymphoid follicles
An appendix blockage can cause bacteria, which in turn cause infection, to build up in the appendix, forcing it to become inflamed. The development of pus and swelling can occur, which leads to the abdominal pain that you feel. However, it’s important to note that many other conditions could cause abdominal pain, and it may not be appendicitis. If the pain is extremely unbearable or if it persists for several hours or days, it’s best to be evaluated by a professional.
What Are the Symptoms of Appendicitis?
Symptoms of appendicitis can easily mimic other abdominal or gastrointestinal conditions. However, the pain experienced from appendicitis is severe, and this should help it stand out from other possible problems.
Symptoms of appendicitis may not begin as debilitating, sharp pain. In fact, abdominal pain may manifest as mild cramping. It could feel like bloating or gas. However, the cramping increases with intensity as the appendix becomes more inflamed.
The important thing to note about appendix pain is that you will feel it radiating from the lower right side of the abdomen. You may also feel pain in the upper abdomen area behind your belly button.
Other symptoms commonly associated with appendicitis include:
- Loss of appetite
- Nausea and/or vomiting
- Low-grade fever
- Abdominal swelling
- Inability to pass gas
- Diarrhea and/or constipation
If constipation is one of the symptoms you’re experiencing, but you also suspect appendicitis, it’s important to remember not to take any laxatives (over-the-counter or otherwise) until you’ve been evaluated by your physician. The taking of laxatives can cause the appendix to burst suddenly, which is a serious medical emergency.
If you’re experiencing one or several of these symptoms, particularly abdominal pain in the right side or right quadrant, it’s best to call your doctor as soon as possible or go to the nearest emergency room or urgent care center.
Tests for Appendicitis
If you suspect appendicitis and visit your doctor or an urgent care center, they will run some tests to confirm the diagnosis. The first thing the doctor will do is to perform a short physical exam. He or she will check for tenderness in the abdomen, which will also determine if the area is swollen or inflamed. Based on the results of this test, the doctor may order additional tests to confirm the diagnosis.
A complete blood count (CBC) is one of the first tests performed to see if the body is fighting off an infection. However, this test alone cannot confirm or deny an appendicitis diagnosis, as it is only checking for bacterial infection. It is not uncommon to be suffering from a bacterial infection such as a urinary tract infection (UTI), which can cause symptoms similar to that of appendicitis. This test is merely the first step in determining some type of infection.
If the CBC shows that you do indeed have an infection, the doctor will likely perform a urine test next. This test can detect a UTI or kidney stones, both of which need to be ruled out when making a definitive appendicitis diagnosis. A urine test may also be used to detect pregnancy, although doctors may also order the pregnancy test along with the blood sample.
Pelvic inflammatory disease (PID) in women can also mimic the symptoms of appendicitis. Depending on the results of your tests, your doctor may want to perform a pelvic exam in order to rule out PID. An ovarian cyst, particularly one that has burst, can also mimic the symptoms of appendicitis. Doctors may be able to determine ovarian cysts via a pelvic exam; however, imaging is the preferred modality to detect both appendicitis as well as cysts or other gynecological issues.
The doctor may also order chest or abdominal imaging exams. This can include abdominal or chest X-ray, a CT scan, ultrasound, or MRI scan. You may wonder why the doctor would order a chest X-ray as well as abdominal imaging, but that is because cases of pneumonia can often mimic appendicitis symptoms. Because many cases of appendicitis end in appendectomy, which is a surgical procedure, the doctor will want to be 100-percent sure of a correct diagnosis.
Treatment Options for Appendicitis
While it’s common knowledge that immediate treatment for appendicitis is appendectomy, its removal, there are other treatment options your physician may try first to avoid surgery. If they can locate an abscess via abdominal imaging, the physician may try to drain the infection to avoid removing the appendix. Other treatment options to help with the infection include antibiotics and IV fluids. If the appendicitis is unresponsive, however, the most common treatment option is surgery. There are two types of appendectomies: laparoscopic surgery and laparotomy surgery. Laparoscopic surgery involves making small incisions to remove the appendix, while laparotomy is a more invasive surgery that uses one single incision for removal.
Acute appendicitis almost always requires surgical intervention. Acute appendicitis is sudden appendicitis that forms over the course of one or two days. The pain involved with an acute case should urge the patient to seek immediate medical treatment. Other, milder forms of appendicitis may respond more to less invasive treatments, such as draining of pus or abscess, antibiotics, and IV fluids. Your doctor can best advise you of which course of action to take.
Without proper treatment and surgery, the mortality rate associated with appendicitis is roughly 50 percent. With treatment, the rate falls to below 1 percent. The appendix can burst, and peritonitis can occur without proper treatment. A burst appendix has the ability to pump infection and bacteria throughout the entire body, which is why it is so dangerous. If your treatment did not involve surgery and appendicitis goes away, you can immediately return to normal activity. If your appendicitis required surgery, make sure to follow your discharge instructions implicitly before returning to work or attempting other potentially taxing tasks. If you need more information on appendicitis or need to be seen by a physician, request an appointment with Dr. Sameer Islam, MD today. He offers a complete battery of gastrointestinal services, with professional, individualized care for all patients.