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Home , Appendectomy, Appendix (anatomy)

National Digestive Information Clearinghouse

The is a small, tube-like structure . Anyone can get appendicitis, attached to the first part of the large intes- but it occurs most often between the ages tine, also called the colon. The appendix of 10 and 30. is located in the lower right portion of National Institute of the abdomen. It has no known function. Diabetes and Removal of the appendix appears to cause Causes Digestive The cause of appendicitis relates to block- and Kidney no change in digestive function. Diseases age of the inside of the appendix, known Appendicitis is an of the as the lumen. The blockage leads to NATIONAL INSTITUTES appendix. Once it starts, there is no effec- increased pressure, impaired blood flow, OF HEALTH tive medical therapy, so appendicitis is and inflammation. If the blockage is not considered a medical emergency. When treated, gangrene and rupture (breaking treated promptly, most patients recover or tearing) of the appendix can result. without difficulty. If treatment is delayed, the appendix can burst, causing infection Most commonly, feces blocks the inside and even death. Appendicitis is the most of the appendix. Also, bacterial or viral common acute surgical emergency of the infections in the digestive tract can lead to

Inflamed appendix

Small intestine Appendix

U.S. Department The appendix is a small, tube-like structure attached to the first part of the large intestine, also called the colon. The of Health and appendix is located in the lower right portion of the abdomen, near where the attaches to the large Services intestine. swelling of lymph nodes, which squeeze People With Special Concerns the appendix and cause obstruction. This Patients with special conditions may not swelling of lymph nodes is known as lym- have the set of symptoms above and may phoid hyperplasia. Traumatic injury to simply experience a general feeling of being the abdomen may lead to appendicitis in a unwell. Patients with these conditions small number of people. Genetics may be a include factor in others. For example, appendicitis that runs in families may result from a • people who use immunosuppressive genetic variant that predisposes a person therapy such as steroids to obstruction of the appendiceal lumen. • people who have received a trans- Symptoms planted Symptoms of appendicitis may include • people infected with the HIV virus • pain in the abdomen, first around • people with diabetes the belly button, then moving to the • people who have cancer or who are lower right area receiving chemotherapy • loss of appetite • obese people • Pregnant women, infants and young chil- • vomiting dren, and the elderly have particular issues. • or , nausea, and vomiting are more common during and may • inability to pass gas or may not be the signs of appendicitis. Many women who develop appendicitis • low fever that begins after other during pregnancy do not experience the symptoms classic symptoms. Pregnant women who • abdominal swelling experience pain on the right side of the abdomen need to contact a doctor. Women Not everyone with appendicitis has all in their third trimester are most at risk. the symptoms. The pain intensifies and worsens when moving, taking deep breaths, Infants and young children cannot commu- coughing, or sneezing. The area becomes nicate their pain history to parents or doc- very tender. People may have a sensation tors. Without a clear history, doctors must called “downward urge,” also known as rely on a physical exam and less specific “tenesmus,” which is the feeling that a symptoms, such as vomiting and fatigue. bowel movement will relieve their discom- Toddlers with appendicitis sometimes have fort. Laxatives and pain medications trouble eating and may seem unusually should not be taken in this situation. sleepy. Children may have constipation, Anyone with these symptoms needs to but may also have small stools that contain see a qualified physician immediately. mucus. Symptoms vary widely among chil- dren. If you think your child has appen- dicitis, contact a doctor immediately.

2 Appendicitis Older patients tend to have more medical Examination of the abdomen helps narrow problems than young patients. The elderly the diagnosis. Location of the pain and often experience less fever and less severe tenderness is important. Pain is a symptom abdominal pain than other patients do. described by a patient; tenderness is the Many older adults do not know that they response to being touched. Two signs, have a serious problem until the appendix called peritoneal signs, suggest that the is close to rupturing. A slight fever and lining of the abdomen is inflamed and sur- abdominal pain on one’s right side are gery may be needed: rebound tenderness reasons to call a doctor right away. and guarding. Rebound tenderness is when the doctor presses on a part of the All patients with special concerns and their abdomen and the patient feels more ten- families need to be particularly alert to a derness when the pressure is released than change in normal functioning and patients when it is applied. Guarding refers to the should see their doctors sooner, rather than tensing of muscles in response to touch. later, when a change occurs. The doctor may also move the patient’s legs to test for pain on flexion of the hip (psoas Diagnosis sign), pain on internal rotation of the hip (obturator sign), or pain on the right side Medical History and Physical when pressing on the left (Rovsing’s sign). Examination These are valuable indicators of inflamma- Asking questions to learn the history of tion but not all patients have them. symptoms and a careful physical examina- tion are key in the diagnosis of appendicitis. Laboratory Tests The doctor will ask many questions—much Blood tests are used to check for signs of like a reporter—trying to understand the infection, such as a high white blood cell nature, timing, location, pattern, and sever- count. Blood chemistries may also show ity of pain and symptoms. Any previous dehydration or fluid and electrolyte disor- medical conditions and , family ders. Urinalysis is used to rule out a urinary history, medications, and allergies are tract infection. Doctors may also order a important information to the doctor. Use pregnancy test for women of childbearing of alcohol, tobacco, and any other drugs age (those who have regular periods). should also be mentioned. This informa- tion is considered confidential and cannot Imaging Tests be shared without the permission of the X rays, ultrasound, and computed tomogra- patient. phy (CT) scans can produce images of the abdomen. Plain x rays can show signs of Before beginning a physical examination, obstruction, perforation (a hole), foreign a nurse or doctor will usually measure vital bodies, and in rare cases, an appendicolith, signs: temperature, pulse rate, breathing which is hardened stool in the appendix. rate, and blood pressure. Usually the phys- Ultrasound may show appendiceal inflam- ical examination proceeds from head to mation and can diagnose gall bladder toe. Many conditions such as pneumonia and pregnancy. By far the most or heart disease can cause abdominal pain. common test used, however, is the CT scan. Generalized symptoms such as fever, rash, This test provides a series of cross-sectional or swelling of the lymph nodes may point to images of the body and can identify many diseases that wouldn’t require .

3 Appendicitis abdominal conditions and facilitate diagno- for 4 to 6 weeks after surgery. Most people sis when the clinical impression is in doubt. treated for appendicitis recover excellently All women of childbearing age should have and rarely need to make any changes in a pregnancy test before undergoing any their diet, exercise, or lifestyle. testing with x rays. and Other In selected cases, particularly in women Treatments when the cause of the symptoms may be either the appendix or an inflamed ovary or If the diagnosis is uncertain, people may fallopian tube, may be neces- be watched and sometimes treated with sary. This procedure avoids radiation, but antibiotics. This approach is taken when requires general anesthesia. A laparoscope the doctor suspects that the patient’s symp- is a thin tube with a camera attached that is toms may have a nonsurgical or medically inserted into the body through a small cut, treatable cause. If the cause of the pain is allowing doctors to see the internal organs. infectious, symptoms resolve with intra- Surgery can then be performed laparoscop- venous antibiotics and intravenous fluids. ically if the condition present requires it. In general, however, appendicitis cannot be treated with antibiotics alone and will require surgery. Treatment Occasionally the body is able to control Surgery an appendiceal perforation by forming an Acute appendicitis is treated by surgery to abscess. An abscess occurs when an infec- remove the appendix. The operation may tion is walled off in one part of the body. be performed through a standard small The doctor may choose to drain the abscess incision in the right lower part of the and leave the drain in the abscess cavity for abdomen, or it may be performed using a several weeks. An may be laparoscope, which requires three to four scheduled after the abscess is drained. smaller incisions. If other conditions are suspected in addition to appendicitis, they may be identified using laparoscopy. In Complications some patients, laparoscopy is preferable to The most serious complication of appen- open surgery because the incision is small- dicitis is rupture. The appendix bursts er, recovery time is quicker, and less pain or tears if appendicitis is not diagnosed medication is required. The appendix is quickly and goes untreated. Infants, young almost always removed, even if it is found children, and older adults are at highest to be normal. With complete removal, any risk. A ruptured appendix can lead to later episodes of pain will not be attributed and abscess. Peritonitis is a to appendicitis. dangerous infection that happens when and other contents of the torn Recovery from appendectomy takes a few appendix leak into the abdomen. In people weeks. Doctors usually prescribe pain with appendicitis, an abscess usually takes medication and ask patients to limit physi- the form of a swollen mass filled with fluid cal activity. Recovery from laparoscopic and bacteria. In a few patients, compli- appendectomy is generally faster, but limit- cations of appendicitis can lead to organ ing strenuous activity may still be necessary failure and death.

4 Appendicitis Hope Through Research For More Information The National Institute of Diabetes and American Academy of Family Physicians Digestive and Kidney Diseases (NIDDK) P.O. Box 11210 conducts and supports research into many Shawnee Mission, KS 66207–1210 kinds of digestive disorders, including some Phone: 1–800–274–2237 related to appendicitis. Email: [email protected] Internet: www.aafp.org American College of Surgeons Points to Remember 633 North Saint Clair Street • The appendix is a small, tube-like Chicago, IL 60611–3211 structure attached to the first part of Phone: (312) 202–5000 the colon. Appendicitis is an inflam- Fax: (312) 202–5001 mation of the appendix. Email: [email protected] Internet: www.facs.org • Appendicitis is considered a medical emergency. American Society of Colon and Rectal Surgeons (ASCRS) • Symptoms of appendicitis include 85 West Algonquin Road pain in the abdomen, loss of Suite 550 appetite, nausea, vomiting, consti- Arlington Heights, IL 60005 pation or diarrhea, inability to pass Phone: (847) 290–9184 gas, low-grade fever, and abdominal Fax: (847) 290–9203 swelling. Not everyone with appen- Email: [email protected] dicitis has all the symptoms. Internet: www.fascrs.org • Physical examination, laboratory National Library of Medicine— tests, and imaging tests are used MEDLINEplus to diagnose appendicitis. Internet: www.nlm.nih.gov/medlineplus • Acute appendicitis is treated by surgery to remove the appendix. • The most serious complication of appendicitis is rupture, which can lead to peritonitis and abscess.

5 Appendicitis National Digestive Diseases Information Clearinghouse 2 Information Way Bethesda, MD 20892–3570 Phone: 1–800–891–5389 or (301) 654–3810 Fax: (301) 907–8906 Email: [email protected] Internet: www.digestive.niddk.nih.gov

The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1980, the clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet was reviewed by Joshua Katz, M.D., George Washington University Medical Center.

This publication is not copyrighted. The clearinghouse encourages users of this fact sheet to duplicate and distribute as many copies as desired. This fact sheet is also available at www. digestive.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health

NIH Publication No. 04–4547 June 2004