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Appendicitis – Symptoms, Causes, and Management

Medically reviewed by Dr. Irfan Ullah Yasir, MBBS, FCPS—Written by Dr. Hamza Waheed, MBBS on August 29, 2021.

Appendicitis is the painful inflammation of the appendix, which is a small tube-shaped organ that projects from the colon. This is characterized by a sharp pain that begins around the navel moving to the lower right side of the abdomen, over time. Pain is intermittent, mild, and cramping in the beginning but becomes steady and severe as it progresses. This condition is a medical emergency that requires immediate surgical intervention, if left untreated, this can prove fatal.

Symptoms of appendicitis

Appendicitis is characterized by some classic symptoms, including:

  • Pain around the belly button
  • Pain in the lower right side of the abdomen
  • Rebound tenderness
  • Loss of appetite
  • Nausea and vomiting
  • Diarrhea or constipation
  • Abdominal swelling
  • Inability to pass gas
  • Fever
  • Pain aggravates upon straining

Causes of appendicitis

The exact function of the appendix is still unknown, which makes it difficult to assess the cause of its inflammation. Most experts believe that the appendix gets inflamed when it is obstructed, there are a lot of things that can potentially obstruct the organ, some of these are:

  • Accumulation of hard stool
  • Tumor
  • Enlarged lymph nodes
  • Pelvic infection
  • Worm infestation
  • Trauma
  • Bladder or urine infections
  • Inflammatory bowel disease
  • Gastroenteritis
  • Digestive tract infections may cause the appendix to become filled with puss

Risk factors

  • Anyone can get appendicitis at any age but it most commonly affects people in the age group between 10 to 30 years
  • Males are more commonly affected than females
  • People with a family history are at a higher risk of developing it

Complications of appendicitis

Appendicitis is an emergency condition that can cause serious complications if not treated on time:

  • An appendix can rupture if it is not surgically removed on time. Thus, spilling all the inflammatory contents into the peritoneal cavity
  • This may result in peritonitis
  • An abscess can also form in the abdomen if the appendix ruptures
  • Septic shock

Acute and chronic appendicitis

Chronic appendicitis is less common and less lethal as compared to its acute form. The pain in the lower abdomen comes and goes over a period of weeks and months until it swells up enough to rupture in chronic appendicitis, whereas the acute condition only takes 2,3 days to develop into its inflamed form. Chronic form is harder to diagnose as the symptoms are not persistent and resemble several other conditions.

Appendicitis in pregnancy

Appendicitis is the most common cause of non-obstetric emergency surgical intervention in pregnant females. Growing uterus can cause the appendix to dislocate and shift upward in the abdomen which may also cause obstruction resulting in appendicitis.

Appendicitis in children

Appendicitis can happen at any age but is more common in people belonging to the age group between 15 and 30 years. The pain due to an inflamed appendix in children, begins at the navel, moving to the right corner of the abdomen, later on, increasing in intensity.

It is often misdiagnosed as UTI or worm infestation as the children fail to explain their symptoms, as well as adults, do. Children younger than 2 years of age experience:

  • Vomiting
  • Abdominal swelling or bloating
  • Abdominal tenderness
  • Older children experience:
  • Nausea and vomiting
  • Pain in the lower right quadrant of the abdomen

Management of appendicitis

Acute appendicitis is an emergency condition that requires emergency management this can result into serious complications.

Diagnosis

Timely diagnosis of appendicitis is very important for its treatment. In case of suspicion, your doctor will perform a physical exam looking for rebound tenderness in the lower right side of the abdomen. To confirm the diagnosis your physician may order one or more investigations.

  • Complete blood count to look for signs of infection
  • Urine test to rule out urinary tract infections or kidney stones
  • Pregnancy test to rule out ectopic pregnancy
  • Ultrasound abdomen and pelvis to look for a painful ovarian cyst
  • CT scan to confirm the case and location

Treatment

Appendicitis can only be treated surgically once the diagnosis is confirmed. Medical treatment is employed prior to surgery to fight milder degrees of inflammation.

Medical treatment

  • Antibiotic therapy is given to fight inflammation in the early stages
  • Over the counter pain, relievers may help relieve the pain to some extent

Surgical treatment

After the initial medical treatment it is treated surgically:

  • An abscess is located at first, which is then drained using a small rubber tube, with the aid of a laparoscope. This drain is left in the body for some time to allow the puss to flow out until the infection subsides.
  • The appendix is removed, a few weeks or months after the abscess has resolved. This procedure is called interval appendectomy and is conducted to avoid recurrence of appendicitis.

Recovery after treatment

Recovery after getting treated for appendicitis depends upon:

  • The type of treatment received by the patient as surgical treatment requires more time to recover
  • Overall well being of the patient
  • Any sort of complications they might have developed from the surgery

Lifestyle changes and home remedies

Appendicitis cannot be prevented but there are some lifestyle changes that can be made to lower the risks:

  • Consume foods that are high in fiber
  • Stay hydrated
  • Have an active lifestyle
  • Avoid strenuous activity right after the surgery
  • Apply pressure on the abdomen before coughing, moving, or laughing
  • Don’t tire yourself out and sleep when you need to

When to consult a doctor?

If you had the antibiotic treatment for previously diagnosed appendicitis and you begin to notice any of these signs you should consult your physician as soon as possible:

  • Fever
  • Puss or infection at the surgical site
  • Intense pain in the lower right side of the abdomen
  • Constipation

FAQ

What are the early warning signs of appendicitis?

  • Severe pain in the lower right quadrant of the abdomen
  • Rebound tenderness
  • Fever
  • Nausea and vomiting followed by loss of appetite

Can appendicitis go away on its own?

Yes, in chronic appendicitis the pain comes and goes for the duration of weeks, months, and sometimes even years. But once the appendix is inflamed enough to rupture, it requires immediate treatment.

How long can you have appendicitis symptoms before it bursts?

Not everyone experiences the symptoms for the same duration of time but an appendix can sometimes rupture as quickly as within 24 to 48 hours.

Last medically reviewed on August 29, 2021.