What are the other Names for this Condition? (Also known as/Synonyms)

• Inflammation of the Appendix

What is Appendicitis? (Definition/Background Information)

• Appendicitis is an inflammation of the appendix, a small, thin pouch that is located at the end of the large intestine (colon). The appendix serves as a storage place for bacteria, so when it becomes blocked, it can become infected
• Appendicitis is a common condition that affects millions of people worldwide. The condition is generally painful; the pain can be intense and excruciating and may be mistaken for other medical conditions. Even light physical strain, such as coughing or walking, can worsen the pain
• In such cases, the individual may require immediate medical attention. In some, Appendicitis is a life-threatening condition that can quickly develop into a medical emergency

There are two forms of Appendicitis, and these include:

• Acute Appendicitis: It is the most common form and is generally caused by an infection in the appendix. It is often severe needing early medical treatment
• Chronic Appendicitis: It is the less common form. In chronic Appendicitis, the symptoms may be relatively mild, and the condition is stated to be less dangerous than the acute form

Who gets Appendicitis? (Age and Sex Distribution)

• Appendicitis is a very common condition worldwide and individuals of any age group, race, or ethnic profile may be affected 
• However, it is more common among older children, teenagers, and young adults (age range 10 and 30 years). Older adults are less commonly affected
• Both male and female genders are affected; but the condition is more common in males than females
• In pregnant women, acute Appendicitis is a relatively commonly diagnosed condition with an incidence rate between 0.04-0.2%
• It is estimated that around 1 in 65-70 individuals with acute Appendicitis develop chronic Appendicitis

According to reports, between 7-9% of individuals in the United States are known to develop acute Appendicitis in their lifetime.

What are the Risk Factors for Appendicitis? (Predisposing Factors)

Even though a common condition, some individuals are at a higher risk for developing Appendicitis than other individuals. The following risk factors are observed:

• Positive family history of the condition
• Older children and teens are at a higher risk for the condition
• Males are at a higher risk than females
• Upper respiratory tract infections

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Appendicitis? (Etiology)

In many cases, the exact cause of development of an Appendicitis is unknown. The condition develops when part of the appendix becomes obstructed or blocked, which can prevent waste elimination from the body. usually, the obstruction occurs from hard stools, enlarged intestinal lymph nodes, or parasitic infections.

The following factors may lead to Appendicitis development:

• Infections
• Inflammatory bowel diseases
• Presence of hard and dry stools in the bowel
• Benign or malignant tumors involving the gastrointestinal tract
• Accidents or injuries
• Enlarged lymphoid follicles
• Presence of parasitic intestinal worms
• Ingestion of foreign materials

Acute Appendicitis occurs when the appendix ruptures. Chronic Appendicitis develops when there is an obstruction in the small or large intestine.

What are the Signs and Symptoms of Appendicitis?

The signs and symptoms of Appendicitis generally include:

• Pain that starts in the middle of the abdomen that becomes severe and constant
• Abdominal pain that may be severe; unilateral lower abdominal pain that lasts several hours or more
• Dull pain that gets worse while lying down; cramping pain in the abdomen
• Pain may increase over time and get worse with laughing, coughing, walking, or applying slight pressure by hand on the area
• Nausea and vomiting; vomiting after eating
• Constipation or diarrhea
• Loss of appetite
• Feeling of fullness (bloating) after eating little
• Swelling and tenderness around the navel region
• Frequently passing gas
• Fever (high temperature)
• Flushed face

Appendicitis is often accompanied by bacterial infection. Infections involving the urinary tract or abdomen may also cause symptoms similar to those of Appendicitis.

In chronic cases of Appendicitis, the symptoms may be relatively mild and are thought to usually occur following a case of acute Appendicitis. The symptoms may “come and go” over a period of weeks, months, or even years. Chronic Appendicitis can be challenging to diagnose and is sometimes not diagnosed until it develops into acute Appendicitis.

How is Appendicitis Diagnosed?

The diagnosis of Appendicitis is generally challenging and may involve the following tests and exams:

• Complete physical exam and evaluation of medical history
• Digital rectal exam and pelvic examination (especially in females)
• Pregnancy test in women, if needed
• Blood tests such as complete blood count (CBC) and C-reactive protein (CRP) tests
• Urine tests such as urinalysis
• Imaging studies such as an abdominal X-ray, ultrasound scan, or CT scan
• Biopsy studies, if necessary

A differential diagnosis may be performed to exclude the following conditions that may present similar signs and symptoms:

• Abdominal abscess
• Fecal impaction
• Gastroenteritis
• Inflammatory bowel disease (IBD)
• Kidney stones
• Menstrual pain and pregnancy in women
• Ovarian cyst
• Pelvic inflammatory disease
• Urinary tract infection (UTI)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Appendicitis?

The complications of Appendicitis may include:

• Rupturing of the appendix resulting in fecal matter spillage into the abdominal cavity that can result in severe pain and life-threatening infections. This can also lead to the following complications:
  • Peritonitis (infection of the abdominal cavity); surgery also carries a risk of peritonitis that can lead to swollen abdomen, rapid heartbeat, and shortness of breath
  • Abscess formation: It is a painful condition of pus collection around the ruptured appendix. In rare cases, bacteria from an abscess may travel through the bloodstream to other parts of the body resulting in sepsis or septicemia
  • Sepsis
• In some cases, chronic appendicitis can also lead to perforation in the appendix
• Complications during pregnancy: Acute Appendicitis is the most common non-obstetric emergency requiring surgery during pregnancy. The symptoms of appendicitis may be mistaken for routine discomfort from pregnancy, which can make it harder to diagnose. The diagnosis is often delayed due to the fact that some cases do not cause any pain until they are severe enough to warrant hospitalization. Delayed diagnosis and treatment may increase your risk of complications, including miscarriage
• Treatment complications: Antibiotics can sometimes cause diarrhea and other side effects. Surgical wound infection is another complication noted

How is Appendicitis Treated?

The treatment of Appendicitis generally depends on the severity of the condition. However, a vast majority of cases require surgical intervention.

• In rare cases, mild cases of Appendicitis may get better with antibiotic therapy. This decision is taken based on the proper evaluation of a healthcare provider
• Appendectomy: Surgical removal of the appendix, which may be minimally-invasive (keyhole or laparoscopic surgery with shorter recovery time) or open appendectomy (open surgery), based on the healthcare provider’s evaluation of the condition and other factors

The following may be recommended by the healthcare provider prior to the surgery:

• Surgical drainage of unruptured abscess, if any present
• Use of pain medication
• Administration of intravenous fluids
• Liquid diet (before and after surgery, for a short period)
• Antibiotics may be recommended in case of any complications

How can Appendicitis be Prevented?

Currently, it may not be possible to prevent Appendicitis. However, the risk for the condition may be lowered through the following measures:

• Regularly having diets rich in fiber such as fruits, vegetables and lentils, including peas and beans
• Healthy lifestyle including drinking plenty of water and exercise regularly, including during pregnancy
• Availing early treatment of gastrointestinal tract disorders and infections

Individuals with chronic appendicitis may be advised the following:

• Avoid eating or drinking anything after midnight
• Use a cold compress (or ice pack) for the pain, as often as required
• Avoid straining while emptying the bowels
• Drink plenty of water

Individuals with mild appendicitis may consider the following measures:

• Drink plenty of water
• Consume more fruits and vegetables; have an easy-to-digest diet to avoid constipation
• Use of painkillers, under advice from the healthcare provider

What is the prognosis of Appendicitis? (Outcomes/Resolutions)

• The outcome of individuals with Appendicitis depend on the following factors:
  • Overall health status of the affected individual
  • Absence or presence of complications
  • Treatment received
  • Timeliness of treatment received
• Following surgery to remove the appendix, recovery may take a few weeks, but the prognosis is typically excellent. In some rare cases, individuals with mild Appendicitis may get better with antibiotics
• A delay in treating the condition or an untreated Appendicitis can potentially lead to severe, life-threatening complications

Additional and Relevant Useful Information for Appendicitis:

Open appendectomy is a surgical procedure for removing the appendix. The following link will provide more information about this surgical procedure:

http://www.dovemed.com/common-procedures/procedures-surgical/open-appendectomy/