What is appendicitis?
Appendicitis is the term used to describe the inflammation of the appendix. The appendix is a small organ that almost looks like a worm hanging on the large intestine. Doctors have not been able to find a legitimate role for the appendix, which is why many surgeons will have it removed during surgery even if it appears to be normal.

What is the appendix?
The appendix is a small pouch that attaches to the large intestine in the lower right area of the abdomen. The large intestine is part of your body’s gastrointestinal (GI) tract. The GI tract consists of a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, helps digest food. The appendix does not appear to have a specific function in the body, and removing it does not seem to affect a person’s health. Appendicitis can happen to anyone, but studies have shown it is more common among people 10 to 30 years old.

What causes appendicitis?
Often times, a blockage in your intestine will cause appendicitis. Blockages are caused by:
  • Backed up stool
  • Parasites
  • Growths
  • Enlarged lymph tissue in the walls of the appendix
  • Inflammatory bowel diseases, such as Crohn’s disease, which cause irritation and ulcers in the digestive tract
  • Trauma to the abdomen
What are the symptoms of appendicitis?
The most common symptom of appendicitis is abdominal pain.

Abdominal pain with appendicitis usually begins near the belly button and may move lower and to the right, gets worse in a matter of hours, or gets worse when you move around, take breaths, or cough.

Other symptoms of appendicitis may include:
  • Loss of appetite
  • Nausea
  • Vomiting
  • Constipation
  • Diarrhea
  • Inability to pass gas
  • Low-grade fever
  • Abdominal swelling
  • Feeling as if a bowel movement will relieve your discomfort
It’s important to know that appendicitis symptoms vary and can mimic other conditions such as intestinal obstructions, Crohn’s disease, ulcerative colitis, pelvic inflammatory disease, or constipation.

How to diagnose appendicitis?
Dr. Khorrami can diagnose most cases of appendicitis by taking your medical history and performing a physical exam.

Dr. Khorrami may also use laboratory (e.g. blood and stool tests) and imaging tests (e.g. CT scan, ultrasound) to confirm that you have appendicitis. These tests are normally performed when you cannot properly describe your symptoms to the specialist.

Medical History
Dr. Khorrami will ask specific questions about symptoms and health history. Answers to these questions will help rule out other conditions:
  • When did your abdominal pain begin?
  • Point to the exact location of your pain.
  • Tell me the severity of the pain.
  • When did other symptoms appear?
  • Have you undergone any surgical procedures? Had any previous illnesses or medical conditions?
  • Do you take any medication, drink alcohol, or use any illegal drugs?
Physical Exam
Details about your abdominal pain are important for diagnosing appendicitis. Dr. Khorrami will assess the pain by touching or applying pressure to specific areas of the abdomen. These include:
    Rovsing’s sign
    Dr. Khorrami tests for Rovsing’s sign by applying hand pressure to the lower left side of the abdomen. Pain felt on the lower right side of the abdomen upon the release of pressure on the left side indicates the presence of Rovsing’s sign.

    Psoas sign
    The right psoas muscle runs over the pelvis near the appendix. Flexing this muscle will cause abdominal pain if the appendix is inflamed. Dr. Khorrami can check for the psoas sign by applying resistance to the right knee as you try to lift your right thigh while lying down.

    Obturator sign
    The right obturator muscle also runs near the appendix. Dr. Khorrami tests for the obturator sign by asking you to lie down with the right leg bent at the knee. Moving the bent knee left and right requires flexing the obturator muscle and will cause abdominal pain if the appendix is inflamed.

    Guarding occurs when a person subconsciously tenses the abdominal muscles during an exam. Voluntary guarding occurs the moment Dr. Khorrami’s hand touches the abdomen. Involuntary guarding occurs before Dr. Khorrami actually makes contact and is a sign the appendix is inflamed.

    Rebound tenderness
    Dr. Khorrami tests for rebound tenderness by applying hand pressure to your lower right abdomen and then letting go. Pain felt upon the release of the pressure indicates rebound tenderness and is a sign the appendix is inflamed. You may also experience rebound tenderness when the abdomen is jarred. A good example of this is when a person bumps into something or goes over a bump in a car.

    Women of childbearing age may be asked to undergo a pelvic exam to rule out gynecological conditions, which sometimes cause abdominal pain similar to appendicitis.

    Dr. Khorrami may also examine the rectum, which can be tender from appendicitis.

    Laboratory Tests
    Laboratory tests can help confirm the diagnosis of appendicitis or find other causes of abdominal pain.

    Blood tests
    A blood test involves drawing a person’s blood at a health care provider’s office or a commercial facility and sending the sample to a laboratory for analysis. Blood tests can show signs of infection, such as a high white blood cell count. Blood tests also may show dehydration or fluid and electrolyte imbalances. Electrolytes are chemicals in the body fluids, including sodium, potassium, magnesium, and chloride.

    Urine samples
    The urine sample is collected in a special container in a health care provider’s office, a commercial facility, or a hospital and can be tested in the same location or sent to a laboratory for analysis. Urine samples are used to rule out urinary tract infections or kidney stones.

    Pregnancy tests
    Dr. Khorrami may order a pregnancy test for women, which can be done through a blood or urine test.
Imaging Tests
Imaging tests can confirm the diagnosis of appendicitis or find other causes of abdominal pain.
    Abdominal ultrasound
    Ultrasound uses a device, called a transducer, which bounces safe, painless sound waves off organs to create an image of their structure. The transducer can be moved to different angles to make it possible to examine different organs. During an abdominal ultrasound, Dr. Khorrami applies gel to your abdomen and moves a hand-held transducer over your skin. The gel allows the transducer to glide easily, and it improves the transmission of the signals. This procedure creates images of the appendix and can show signs of inflammation, a burst appendix, a blockage in the appendiceal lumen, and other sources of abdominal pain such as kidney stones. Ultrasound is sometimes the first imaging test performed for suspected appendicitis in infants, children, young adults, and pregnant women.

    Magnetic resonance imaging (MRI)
    MRI machines use radio waves and magnets to produce detailed pictures of the body’s internal organs and soft tissues without using x-rays. Anesthesia is not needed, though children and people with a fear of confined spaces may receive light sedation, taken by mouth. An MRI may include the injection of special dye, called contrast medium. With most MRI machines, you will lie on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some machines are designed to allow the person to lie in a more open space. An MRI can show signs of inflammation, a burst appendix, a blockage in the appendiceal lumen, and other sources of abdominal pain. An MRI used to diagnose appendicitis and other sources of abdominal pain. An MRI is a safe, reliable alternative to a computerized tomography (CT) scan.

    CT scan
    CT scans use a combination of x-rays and computer technology to create three-dimensional (3-D) images. For a CT scan, the person may be given a solution to drink and an injection of contrast medium. CT scans require you to lie on a table that slides into a tunnel-shaped device where the x-rays are taken. Anesthesia is not needed. A CT scan of the abdomen can show signs of inflammation, such as an enlarged appendix or an abscess, which is a pus-filled mass that results from the body’s attempt to keep an infection from spreading. Other sources of abdominal pain include a burst appendix and a blockage in the appendiceal lumen. Women of childbearing age should have a pregnancy test before undergoing a CT scan as the radiation used in CT scans can be harmful to a developing fetus.
How is appendicitis treated?
Surgery is the most preferred choice. The procedure, which is called an appendectomy, can be done in two ways: laparotomy or laparoscopic surgery. A laparotomy is the traditional method of a single incision to remove the inflamed appendix. Laparoscopic surgeries involve several incisions that use specialized tools to remove your appendix.

Laparoscopic surgeries are the preferred route as they are associated with shorter recovery periods. After surgery has taken place, it is advised that patients stay away from any physical activity for about a week to ensure a successful recovery. For laparatomies, Dr. Khorrami will suggest that you steer away from physical activity for up to 2 weeks.

What are the complications and treatment of a burst appendix?
When an appendix is left inflamed, it has the possibility of rupturing, which can spill harmful fluids into your abdomen. These spilled fluids have a chance of developing into peritonitis. Peritonitis is an inflammation of the abdominal cavity’s lining that could be life threatening. The spilled fluids can also lead to an infectious sac-like formation of pus called an abscess.

What if the surgeon finds a normal appendix?
In this case, many surgeons will remove it to eliminate the future possibility of appendicitis. Occasionally, surgeons find a different problem, which may also be corrected during surgery.

Can appendicitis be treated without surgery?
The use of antibiotics can stave off an infection that may be causing your appendix to become inflamed, but many doctors will suggest that an appendix be removed even if it appears to be responding to antibiotics. The reason why is because appendices have the chance of rupturing, which could spread infection through your entire abdomen. This highly increases your chances of developing peritonitis, a condition that will leave you violently ill and perhaps even be fatal if not promptly taken care of.

Discuss Your Options with Dr. Khorrami
It’s important to realize that appendicitis is an emergency that requires prompt treatment. If you suspect that you may have a case of appendicitis, then contact Dr. Khorrami detailing your symptoms and situation. Most patients recover very quickly if an appendix is removed before it ruptures.

Source contains material from the National Digestive Diseases Information Clearinghouse (NDDIC).


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About Dr. Khorrami

Dr. Payman Khorrami is a UCLA graduate, has been in practice since 1996, and is double board certified. Undergraduate Education at University of California, Berkeley, Medical School at University of California, San Francisco, Internal Medicine Training at University of California, San Diego Read Full Bio