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Appendicitis

Appendicitis is inflammation of the appendix. The appendix is a small pouch attached to the large intestine.

Causes

Appendicitis is a very common cause of emergency surgery. The problem most often occurs when the appendix becomes blocked by feces, a foreign object, or rarely, a tumor.

Symptoms

The symptoms of appendicitis can vary. It can be hard to diagnose appendicitis in young children, older people, and women of childbearing age.

The first symptom is often pain around the belly button or mid upper abdomen. Pain may be minor at first, but becomes more sharp and severe. You may also have a loss of appetite, nausea, vomiting, and a low-grade fever.

The pain tends to move into the right lower part of your belly. The pain tends to focus at a spot directly above the appendix called McBurney point. This most often occurs 12 to 24 hours after the illness starts.

Your pain may be worse when you walk, cough, or make sudden movements. Later symptoms include:

  • Chills and shaking
  • Hard stools
  • Diarrhea
  • Fever
  • Nausea and vomiting

Exams and Tests

Your health care provider may suspect appendicitis based on the symptoms you describe.

Your provider will do a physical exam.

  • If you have appendicitis, your pain will increase when your lower right belly area is pressed.
  • If your appendix has ruptured, touching the belly area may cause a lot of pain and lead you to tighten your muscles.
  • A rectal exam may find tenderness on the right side of your rectum.

A blood test will often show a high white blood cell count. Imaging tests may also help diagnose appendicitis. Imaging tests include:

Treatment

Most of the time, a surgeon will remove your appendix as soon as you are diagnosed.

If a CT scan shows that you have an abscess, you may be treated with antibiotics first. You will have your appendix removed after the infection and swelling have gone away.

The tests used to diagnose appendicitis are not perfect. As a result, the operation may show that your appendix is normal. In that case, the surgeon will remove your appendix and explore the rest of your abdomen for other causes of your pain.

Outlook (Prognosis)

Most people recover quickly after surgery if the appendix is removed before it ruptures.

If your appendix ruptures before surgery, recovery may take longer. You are also more likely to develop problems, such as:

  • An abscess
  • Blockage of the intestine
  • Infection inside the abdomen (peritonitis)
  • Infection of the wound after surgery

When to Contact a Medical Professional

Call your provider if you have abdominal pain in the lower-right portion of your belly, or other symptoms of appendicitis.

References

Sarosi GA. Appendicitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 120.

Sifri CD, Madoff LC. Appendicitis. In: Bennett E, Dolin R, Blaser MJ, eds. Mandell, Douglass, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 80.

Smith MP, Katz DS, Lalani T, et al. ACR appropriateness criteria right lower quadrant pain -- suspected appendicitis. Ultrasound Q. 2015;31(2):85-91. PMID: 25364964 www.ncbi.nlm.nih.gov/pubmed/25364964.

Wolfe JM, Henneman PL. Acute appendicitis. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 93.

    • Anatomical landmarks, front view

      Anatomical landmarks, front view - illustration

      There are three body views (front, back and side) that may be helpful if you are uncertain of a body area. Many areas are referred to by both descriptive and technical names. For example, the back of the knee is called the popliteal fossa. However, areas like the "flank" may not have both names, so the location may be unclear.

      Anatomical landmarks, front view

      illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Appendectomy - Series

      Appendectomy - Series

      Presentation

    • Appendicitis

      Appendicitis - illustration

      The appendix is a small finger-shaped tube that branches off the first part of the large intestine. The appendix can become inflamed or infected causing pain in the lower right part of the abdomen.

      Appendicitis

      illustration

      • Anatomical landmarks, front view

        Anatomical landmarks, front view - illustration

        There are three body views (front, back and side) that may be helpful if you are uncertain of a body area. Many areas are referred to by both descriptive and technical names. For example, the back of the knee is called the popliteal fossa. However, areas like the "flank" may not have both names, so the location may be unclear.

        Anatomical landmarks, front view

        illustration

      • Digestive system

        Digestive system - illustration

        The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

        Digestive system

        illustration

      • Appendectomy - Series

        Presentation

      • Appendicitis

        Appendicitis - illustration

        The appendix is a small finger-shaped tube that branches off the first part of the large intestine. The appendix can become inflamed or infected causing pain in the lower right part of the abdomen.

        Appendicitis

        illustration

      Review Date: 4/4/2017

      Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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