appendicitis

Appendicitis 

Definition

Appendicitis is an inflammation of the appendix, which is the worm-shaped pouch attached to the cecum, the beginning of the large intestine. The appendix has no known function in the body, but it can become diseased. Appendicitis is a medical emergency, and if it is left untreated the appendix may rupture and cause a potentially fatal infection.

Description

Appendicitis is the most common abdominal emergency found in children and young adults. One person in 15 develops appendicitis in his or her lifetime. The incidence is highest among males aged 10-14, and among females aged 15-19. More males than females develop appendicitis between puberty and age 25. It is rare in the elderly and in children under the age of two.

The hallmark symptom of appendicitis is increasingly severe abdominal pain. Since many different conditions can cause abdominal pain, an accurate diagnosis of appendicitis can be difficult. A timely diagnosis is important, however, because a delay can result in perforation, or rupture, of the appendix. When this happens, the infected contents of the appendix spill into the abdomen, potentially causing a serious infection of the abdomen called peritonitis.

Other conditions can have similar symptoms, especially in women. These include pelvic inflammatory disease, ruptured ovarian follicles, ruptured ovarian cysts, tubal pregnancies, and endometriosis. Various forms of stomach upset and bowel inflammation may also mimic appendicitis.

The treatment for acute (sudden, severe) appendicitis is an appendectomy, surgery to remove the appendix. Because of the potential for a life-threatening ruptured appendix, persons suspected of having appendicitis are often taken to surgery before the diagnosis is certain.

Causes and symptoms

The causes of appendicitis are not well understood, but it is believed to occur as a result of one or more of these factors: an obstruction within the appendix, the development of an ulceration (an abnormal change in tissue accompanied by the death of cells) within the appendix, and the invasion of bacteria.

Under these conditions, bacteria may multiply within the appendix. The appendix may become swollen and filled with pus (a fluid formed in infected tissue, consisting of while blood cells and cellular debris), and may eventually rupture. Signs of rupture include the presence of symptoms for more than 24 hours, a fever, a high white blood cell count, and a fast heart rate. Very rarely, the inflammation and symptoms of appendicitis may disappear but recur again later.

The distinguishing symptom of appendicitis is pain beginning around or above the navel. The pain, which may be severe or only achy and uncomfortable, eventually moves into the right lower corner of the abdomen. There, it becomes more steady and more severe, and often increases with movement, coughing, and so forth. The abdomen often becomes rigid and tender to the touch. Increasing rigidity and tenderness indicates an increased likelihood of perforation and peritonitis.

Loss of appetite is very common. Nausea and vomiting may occur in about half of the cases and occasionally there may be constipation or diarrhea. The temperature may be normal or slightly elevated. The presence of a fever may indicate that the appendix has ruptured.

Diagnosis

A careful examination is the best way to diagnose appendicitis. It is often difficult even for experienced physicians to distinguish the symptoms of appendicitis from those of other abdominal disorders. Therefore, very specific questioning and a thorough physical examination are crucial. The physician should ask questions, such as where the pain is centered, whether the pain has shifted, and where the pain began. The physician should press on the abdomen to judge the location of the pain and the degree of tenderness.

The typical sequence of symptoms is present in about 50% of cases. In the other half of cases, less typical patterns may be seen, especially in pregnant women, older patients, and infants. In pregnant women, appendicitis is easily masked by the frequent occurrence of mild abdominal pain and nausea from other causes. Elderly patients may feel less pain and tenderness than most patients, thereby delaying diagnosis and treatment, and leading to rupture in 30% of cases. Infants and young children often have diarrhea, vomiting, and fever in addition to pain.

While laboratory tests cannot establish the diagnosis, an increased white cell count may point to appendicitis. Urinalysis may help to rule out a urinary tract infection that can mimic appendicitis.

Key terms

Appendectomy (or appendicectomy) — Surgical removal of the appendix.

Appendix — The worm-shaped pouch attached to the cecum, the beginning of the large intestine.

Laparotomy — Surgical incision into the loin, between the ribs and the pelvis, which offers surgeons a view inside the abdominal cavity.

Peritonitis — Inflammation of the peritoneum, membranes lining the abdominal pelvic wall.

Patients whose symptoms and physical examination are compatible with a diagnosis of appendicitis are usually taken immediately to surgery, where a laparotomy (surgical exploration of the abdomen) is done to confirm the diagnosis. In cases with a questionable diagnosis, other tests, such as a computed tomography scan (CT) may be performed to avoid unnecessary surgery. An ultrasound examination of the abdomen may help to identify an inflamed appendix or other condition that would explain the symptoms. Abdominal x-rays are not of much value except when the appendix has ruptured.

Often, the diagnosis is not certain until an operation is done. To avoid a ruptured appendix, surgery may be recommended without delay if the symptoms point clearly to appendicitis. If the symptoms are not clear, surgery may be postponed until they progress enough to confirm a diagnosis.

When appendicitis is strongly suspected in a woman of child-bearing age, a diagnostic laparoscopy (an examination of the interior of the abdomen) is sometimes recommended before the appendectomy in order to be sure that a gynecological problem, such as a ruptured ovarian cyst, is not causing the pain. In this procedure, a lighted viewing tube is inserted into the abdomen through a small incision around the navel.

A normal appendix is discovered in about 10-20% of patients who undergo laparotomy, because of suspected appendicitis. Sometimes the surgeon will remove a normal appendix as a safeguard against appendicitis in the future. During the surgery, another specific cause for the pain and symptoms of appendicitis is found for about 30% of these patients.

Treatment

The treatment of appendicitis is an immediate appendectomy. This may be done by opening the abdomen in the standard open appendectomy technique, or through laparoscopy. In laparoscopy, a smaller incision is made through the navel. Both methods can successfully accomplish the removal of the appendix. It is not certain that laparoscopy holds any advantage over open appendectomy. When the appendix has ruptured, patients undergoing a laparoscopic appendectomy may have to be switched to the open appendectomy procedure for the successful management of the rupture. If a ruptured appendix is left untreated, the condition is fatal.

Prognosis

Appendicitis is usually treated successfully by appendectomy. Unless there are complications, the patient should recover without further problems. The mortality rate in cases without complications is less than 0.1%. When an appendix has ruptured, or a severe infection has developed, the likelihood is higher for complications, with slower recovery, or death from disease. There are higher rates of perforation and mortality among children and the elderly.

Prevention

Appendicitis is probably not preventable, although there is some indication that a diet high in green vegetables and tomatoes may help prevent appendicitis.

Resources

Periodicals

Van Der Meer, Antonia. "Do You Know the Warning Signs of Appendicitis?" Parents Magazine (April 1997): 49.

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appendicitis /ap·pen·di·ci·tis/ (ah-pen″dĭ-si´tis) inflammation of the vermiform appendix.

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acute appendicitis  appendicitis of acute onset, requiring prompt surgery, and usually marked by pain in the right lower abdominal quadrant, referred rebound tenderness, overlying muscle spasm, and cutaneous hyperesthesia.

chronic appendicitis 

1. that characterized by fibrotic thickening of the organ wall due to previous acute inflammation.

2. formerly, chronic or recurrent pain in the appendiceal area, without evidence of acute inflammation.

fulminating appendicitis  that marked by sudden onset and usually death.

gangrenous appendicitis  that complicated by gangrene of the organ, due to interference of blood supply.

obstructive appendicitis  a common form with obstruction of the lumen, usually by a fecalith.

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ap·pen·di·ci·tis (-pnd-sts)

n.

Inflammation of the vermiform appendix.

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appendicitis

[əpen′disī′tis]

Etymology: L, appendere + Gk, itis

an inflammation of the vermiform appendix, usually acute, that, if undiagnosed, leads rapidly to perforation and peritonitis. The inflammation is caused by an obstruction such as a hard mass of feces or a foreign body in the lumen of the appendix, lymphoid hyperplasia, fibrous disease of the intestinal wall, an adhesion, or a parasitic infestation. Appendicitis is most likely to occur in teenagers and young adults and is more prevalent in male patients. One kind of appendicitis is chronic appendicitis.

observations The most common symptom is constant pain in the right lower quadrant of the abdomen around McBurney's point, which the patient describes as having begun as intermittent pain in midabdomen. Rebound tenderness occurs at McBurney's point as well. Pain may also occur on the left side. Extreme tenderness occurs over the right rectus abdominis muscle. To decrease the pain, the patient keeps the knees bent to prevent tension of the abdominal muscles. Appendicitis is characterized by vomiting, a low-grade fever of 99° to 102° F, an elevated white blood cell count, rebound tenderness, a rigid abdomen, and decreased or absent bowel sounds. Other indications of peritonitis include increasing abdominal distension, acute abdomen, tachycardia, rapid and shallow breathing, and restlessness. If peritonitis is suspected, IV antibiotic therapy, fluids, and electrolytes are given.

nursing considerations The nurse is alert to the signs and symptoms of rupture and peritonitis and provides education about the diagnosis, treatment, and recovery.

interventions Treatment is appendectomy within 24 to 48 hours of the first symptoms because delay usually results in rupture and peritonitis as fecal matter is released into the peritoneal cavity. The fever rises sharply once peritonitis begins. The patient may have sudden relief from pain immediately after rupture, followed by increased, diffuse pain.

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appendicitis,

n an inflammation of the vermiform appendix, usually acute, which, if undiagnosed and not surgically removed, leads rapidly to perforation and peritonitis.

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appendicitis

inflammation of the vermiform appendix. Occurs in humans and the great apes. The syndrome includes abdominal pain, fever and leukocytosis.

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appendicitis

Surgery Inflammation of the vermiform appendix which is most common in children Clinical Right lower quadrant pain of acute onset, rebound tenderness over McBurney's point in right hypogastrium, fever, anorexia, constipation, diarrhea, N&V Lab ↑ WBCs, left shift of WBCs, ↑ ESR Diagnosis Hx, PE, ultrasound, CT Management Appendectomy Complications Rupture, purulent peritonitis; untreated, death. See Appendix. Cf Left-sided appendicitis.

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Patient discussion about appendicitis.

Q. how can i differentiate between normal stomach ache and an Appendicitis? I've been having a strange sharp pain in my stomach lately and a friend of mine told me it could be Appendicitis.

A. When you have Appendicitis, there should be a sharp pain on the right lower Abdomen. but you mustn't forget that Appendicitis is an inflammation. which means you'll have a fever some time in the near future, and it always get worse. not like other Abdominal pains. you'll vomit probably. i had my Appendix removed 2 years ago. don't worry, it's not too bad ;).

Q. What Causes Acute Appendicitis? I've heard that appendicitis is a very common situation. What causes it to happen? Is there a way to avoid it?

A. Appendicitis is caused by an infection of the appendix, usually from bacterias that are already located in the abdomen. It is not a situation that can be avoided and can occur in a high prevalence in the population.

Q. What is Acute Appendictis? My husband had to go to the emergency room last night because of sudden severe stomach aches. The doctors said he had acute appendictis and needed urgent operation. What is acute appendicitis?

A. The term 'Appendictis' refers to an inflammed appendix, an organ that is located in the right lower part of the abdomen, attached to the cecum, which is a part of the intestine. The appendix is often infected with intestinal bacteria, and such an infection can cause severe symptoms, that require receiving emergent medical care. If indeed acute appendicitis is diagnosed, the treatment involves immediate surgery, for the removal of the infected appendix.