Signs and Symptoms of Appendicitis
Appendicitis is inflammation and infection of the appendix, a short, tubular structure that sticks out at the junction of the small intestine and large intestine (colon), in the right lower quadrant of the abdominal cavity. It doesn’t have nerves that feel pain, so when it gets blocked by a piece of stool or a swollen lymph node and begins swelling, the stretch is felt as a general, vague uncomfortable feeling in the center of the abdomen, near the belly button. It isn’t until the appendix becomes inflamed enough to irritate the lining of the abdomen — the peritoneum — which does have nerves that feel pain, that we feel the pain exactly where the problem is, usually in the lower right abdomen. This is when most people get concerned, but the first signs of appendicitis are frequently vague and often dismissed as “bad food,” gas pains, or just a few cramps. Once appendicitis begins, the intestines generally do not want to work normally. Your body tells you, “I don’t want food right now,” and you don’t feel hungry. In children especially, if they wouldn’t want to eat their favorite food, and they are complaining of abdominal pain or other symptoms described here, suspicion for appendicitis might be higher. Also with appendicitis, pain or discomfort almost always comes before nausea and vomiting. Though not all will, many patients with appendicitis feel like throwing up, whether they do or not. This goes along with not being hungry. Another possible symptom is diarrhea, which signifies the intestines are irritated and trying to empty themselves. As the infection progresses, many patients feel hot and have temperatures higher than normal. Some patients experience chills instead, and feel cold or have shivers, when others around them do not. Sometimes, it is possible to feel chilled and have a fever at the same time. Pain with movement or shaking of the abdomen is an indicator of peritonitis, or inflammation of the peritoneal lining. This is usually a later sign of appendicitis, once the appendix itself is inflamed or infected enough to irritate the peritoneum, at least locally. If the pain extends outside the lower right abdomen, it could be a sign that the appendix has ruptured, or broken open, and infected fluid or pus is present in the abdominal cavity. In some patients, their pain gets worse and worse, and then suddenly gets better or completely goes away. This is actually a bad sign, and may indicate rupture of the appendix, as the pain due to the pressure building up in the swollen appendix is relieved when it opens, leaking infected contents into the abdomen.
Diagnosis of Appendicitis
The doctor will take a careful history, asking about when and how your symptoms started, like pain or vomiting, and whether there have been changes since they started. A physical examination enables your doctor to evaluate for presence and degree of tenderness, and blood is drawn to check labs related to infection, dehydration and other possible causes of your symptoms. Imaging may be performed, most commonly a CT scan, which can show the doctor if the appendix is enlarged or inflamed.
Treatment for Appendicitis
Most often, surgery is recommended for acute appendicitis, along with antibiotics while in the hospital. In most cases, the appendix can be removed laparoscopically, with a few small incisions, through which a special camera and instruments are used to perform the operation. Carbon dioxide is introduced into the abdominal cavity, which expands, allowing the surgeon to see the intestines and appendix clearly. An anesthesiologist puts the patient to sleep for the operation, and wakes them up afterward. Pain from the incisions is managed with oral medication, and you should be able to eat soon after surgery. Recovery time is usually shorter than with a longer incision directly over the appendix (“open” appendectomy), although one may still be necessary in some cases.
In the case of ruptured appendicitis, you may be treated with IV antibiotics without surgery initially. If there is an abscess present, or an organized collection of infected fluid, a drain tube may be placed through the skin by a radiologist, guided by CT scan, to evacuate the pus. In these cases, most patients return 6-8 weeks after recovery for an interval appendectomy, to have their appendix removed once the inflammation has resolved. This is frequently done laparoscopically as outpatient, “same-day” surgery.