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The appendix is a small, worm-like appendage attached to the colon.

Appendicitis occurs when bacteria invade and infect the wall of the appendix.

The most common complications of appendicitis are abscess and peritonitis.

The most common symptoms of appendicitis are abdominal pain, loss of
appetite, nauseaand vomiting, fever, and abdominal tenderness.

Appendicitis usually is suspected on the basis of a patient's history and physical
examination; however, a white blood cell count, urinalysis, abdominal X-ray, barium enema,
ultrasonography, CT scan, andlaparoscopy also may be helpful in diagnosis.

Due to the varying size and location of the appendix and the proximity of other organs to
the appendix, it may be difficult to differentiate appendicitis from other abdominal and pelvic

The treatment for appendicitis usually is antibiotics and appendectomy (appendectomy or
surgery to remove the appendix).

Complications of appendectomy include wound infection and abscess.
Other conditions that can mimic appendicitis include Meckel'sdiverticulitis, pelvic
inflammatory disease (PID), inflammatory diseases of the right upper abdomen (gallbladder
disease, liver disease, or perforated duodenal ulcer), right-sided diverticulitis, and kidney

What is the appendix?
The appendix is a closed-ended, narrow tube up to several inches in length that attaches to the
cecum (the first part of the colon) like a worm. (The anatomical name for the appendix, vermiform
appendix, means worm-like appendage.) The open central core of the appendix drains into the
cecum. The inner lining of the appendix produces a small amount of mucus that flows through
the open central core of the appendix and into the cecum. The wall of the appendix contains
lymphatic tissue that is part of the immune system for making antibodies. Like the rest of the
colon, the wall of the appendix also contains a layer of muscle, but the layer of muscle is poorly

What is appendicitis and what causes appendicitis?
Appendicitis means inflammation of the appendix. It is thought that appendicitis begins when the
opening from the appendix into the cecum becomes blocked. The blockage may be due to a
build-up of thick mucus within the appendix or to stool that enters the appendix from the cecum.
The mucus or stool hardens, becomes rock-like, and blocks the opening. This rock is called a
fecalith (literally, a rock of stool). At other times, it might be that the lymphatic tissue in the
appendix swells and blocks the opening. After the blockage occurs, bacteria which normally are
found within the appendix begin to invade (infect) the wall of the appendix. The body responds to
the invasion by mounting an attack on the bacteria, an attack called inflammation. An alternative

theory for the cause of appendicitis is an initial rupture of the appendix followed by spread of
bacteria outside of the appendix. The cause of such a rupture is unclear, but it may relate to
changes that occur in the lymphatic tissue, for example, inflammation, that lines the wall of the
If the inflammation and infection spread through the wall of the appendix, the appendix can
rupture. After rupture, infection can spread throughout the abdomen; however, it usually is
confined to a small area surrounding the appendix (forming a peri-appendiceal abscess).
Sometimes, the body is successful in containing ("healing") the appendicitis without surgical
treatment if the infection and accompanying inflammation do not spread throughout the
abdomen. The inflammation, pain and symptoms may disappear. This is particularly true in
elderly patients and when antibiotics are used. The patients then may come to the doctor long
after the episode of appendicitis with a lump or a mass in the right lower abdomen that is due to
the scarring that occurs during healing. This lump might raise the suspicion of cancer.

What are the complications of appendicitis?
The most frequent complication of appendicitis is perforation. Perforation of the appendix can
lead to a peri-appendiceal abscess (a collection of infected pus) or diffuse peritonitis (infection of
the entire lining of the abdomen and the pelvis). The major reason for appendiceal perforation is
delay in diagnosis and treatment. In general, the longer the delay between diagnosis and
surgery, the more likely is perforation. The risk of perforation 36 hours after the onset of
symptoms is at least 15%. Therefore, once appendicitis is diagnosed, surgery should be done
without unnecessary delay.
A less common complication of appendicitis is blockage or obstruction of the intestine. Blockage
occurs when the inflammation surrounding the appendix causes the intestinal muscle to stop
working, and this prevents the intestinal contents from passing. If the intestine above the
blockage begins to fill with liquid and gas, the abdomen distends and nausea and vomiting may

Rebound tenderness is pain that is worse when the doctor quickly releases his or her hand after gently pressing on the abdomen over the area of tenderness. The exact point is named after Dr. What are the symptoms of appendicitis? The main symptom of appendicitis isabdominal pain. Almost any infection or inflammation can cause this count to be abnormally high. Most patients with . Nausea and vomiting also may occur later due to intestinal obstruction. the pain changes and then can be localized clearly to one small area.) The pain is so difficult to pinpoint that when asked to point to the area of the pain. most people indicate the location of the pain with a circular motion of their hand around the central part of their abdomen. A second. and there usually will be moderate to severe tenderness in the right lower abdomen when the doctor pushes there. the pain becomes diffuse again as the entire lining of the abdomen becomes inflamed. including the appendix. before infection sets in. Fortunately. The pain is at first diffuse and poorly localized. white blood cells and bacteria in the urine. Therefore. not confined to one spot. This is a very serious. White Blood Cell Count The white blood cell count in the blood usually becomes elevated with infection. Once the peritoneum becomes inflamed. a condition in which infecting bacteria enter the blood and travel to other parts of the body. A feared complication of appendicitis issepsis. an elevated white blood cell count alone cannot be used to confirm a diagnosis of appendicitis. it can spread to the ureter and bladder leading to an abnormal urinalysis. early symptom of appendicitis is loss of appetite which may progress to nausea and even vomiting. If inflammation has spread to the peritoneum. Urinalysis Urinalysis is a microscopic examination of the urine that detects red blood cells. In early appendicitis. but most often there is at least a mild elevation even early in the process. appendicitis is not the only condition that causes elevated white blood cell counts. How is appendicitis diagnosed? The diagnosis of appendicitis begins with a thorough history and physical examination. If the inflammation of appendicitis is great enough. even life-threatening complication. it occurs infrequently. it extends through the appendix to its outer covering and then to the lining of the abdomen.occur. it can be normal. Charles McBurney--McBurney's point. If the appendix ruptures and infection spreads throughout the abdomen. that is. The urinalysis also may be abnormal with appendicitis because the appendix lies near the ureter and bladder. (Poorly localized pain is typical whenever a problem is confined to the small intestine or colon. a thin membrane called the peritoneum. this area is between the front of the right hip bone and the belly button. As appendiceal inflammation increases. Unfortunately. It then may be necessary to drain the contents of the intestine through a tube passed through the nose and esophagus and into the stomach and intestine. Patients often have an elevated temperature. Generally. Urinalysis usually is abnormal when there is inflammation or stones in the kidneys or bladder. common. there is frequently rebound tenderness.

Computerized tomography (CT) Scan In patients who are not pregnant. Abdominal X-Ray An abdominal x-ray may detect the fecalith (the hardened and calcified. There is no one test that will diagnose appendicitis with certainty. Therefore.appendicitis. however. Laparoscopy allows a direct view of the appendix as well as other abdominal and pelvic organs. Therefore. pea-sized piece of stool that blocks the appendiceal opening) that may be the cause of appendicitis. Therefore. has a mesentery. Ultrasound An ultrasound is a painless procedure that uses sound waves to provide images of identify organs within the body. or surgery. Barium enema also can exclude other intestinal problems that mimic appendicitis. Fallopian tubes and uterus that can mimic appendicitis. show an impression on the colon in the area of the appendix where the inflammation from the adjacent inflammation impinges on the colon. a CT scan of the area of the appendix is useful in diagnosing appendicitis and peri-appendiceal abscesses as well as in excluding other diseases inside the abdomen and pelvis that can mimic appendicitis. during appendicitis. The combination of a large mesentery and a long appendix allows the appendix to dip down into the pelvis (among the pelvic organs in women). tests as previously discussed. like other parts of the intestine. This is especially true in children. In addition. Ultrasound also is helpful in women because it can exclude the presence of conditions involving the ovaries. the approach to suspected appendicitis may include a period of observation. Ultrasound can identify an enlarged appendix or an abscess. It also may allow the appendix to move behind the colon (called a . Nevertheless. This test can. but the appendix. a normal urinalysis suggests appendicitis more than a urinary tract problem. at times. The position of the appendix in the abdomen may vary. If the mesentery is large. Why can it be difficult to diagnose appendicitis? It can be difficult to diagnose appendicitis. Most of the time the appendix is in the right lower abdomen. Laparoscopy Laparoscopy is a surgical procedure in which a small fiberoptic tube with a camera is inserted into the abdomen through a small puncture made on the abdominal wall. not seeing the appendix during an ultrasound does not exclude appendicitis. This mesentery is a sheet-like membrane that attaches the appendix to other structures within the abdomen. the inflamed appendix can be removed with the laparoscope. The disadvantage of laparoscopy compared to ultrasound and CT is that it requires a general anesthetic. for exampleCrohn's disease. Barium Enema A barium enema is an X-ray test in which liquid barium is inserted into the colon from the anus to fill the colon. it allows the appendix to move around. the appendix may be longer than normal. If appendicitis is found. the appendix can be seen in only 50% of patients. have a normal urinalysis.

gallbladder disease. A Meckel's diverticulum is a small outpouching of the small intestine which usually is located in the right lower abdomen near the appendix. for example. another condition. In either case. Therefore. How is appendicitis treated? Once a diagnosis of appendicitis is made. however. a person may not see their doctor until appendicitis with rupture has been present for many days or even weeks. or inflammatorydiseases of the liver. On occasion. The right Fallopian tube and ovary lie near the appendix. This type of appendicitis is referred to as "confined appendicitis" and may be treated with antibiotics alone. Such fluids may come from a perforated duodenal ulcer. antibiotic therapy is sufficient treatment. perhaps. it is common to observe patients with suspected appendicitis for a period of time to see if the problem will resolve on its own or develop characteristics that more strongly suggest appendicitis or. The diverticulum may become inflamed or even perforate (break open or rupture). they occasionally occur on the right side. for example. a woman's pelvic organs. These patients usually are not very ill and improve during several days of observation.retro-colic appendix). Antibiotics almost always are begun prior to surgery and as soon as appendicitis is suspected.  Kidney diseases. The body is able not only to contain the inflammation and infection but to resolve it as well. an abscess usually has formed. When a right-sided diverticulum ruptures it can provoke inflammation they mimics appendicitis. and the appendiceal perforation may have closed over. Although most diverticuli are located on the left side of the colon. it initially can be treated with antibiotics. it usually is removed surgically. an abscess-can mimic appendicitis. What other conditions can mimic appendicitis? The surgeon faced with a patient suspected of having appendicitis always must consider and look for other conditions that can mimic appendicitis.  Inflammatory diseases of the right upper abdomen. and surgical removal of the tube and ovary are not necessary. The right kidney is close enough to the appendix that inflammatory problems in the kidney-for example. A drain (a small plastic or rubber tube) usually is inserted through the skin and into the abscess with the aid of an ultrasound or CT . inflammation of the appendix may appear to be more like the inflammation of other organs. If inflamed and/or perforated. Among the conditions that mimic appendicitis are:  Meckel's diverticulitis. In this situation.  Pelvic inflammatory disease. There is a small group of patients in whom the inflammation and infection of appendicitis remain mild and localized to a small area. If the abscess is small. The diagnosis of appendicitis also can be difficult because other inflammatory problems may mimic appendicitis. Fluids from the right upper abdomen may drain into the lower abdomen where they stimulate inflammation and mimic appendicitis. The appendix may or may not be removed at a later time. Usually. an appendectomy usually is performed. the abscess usually requires drainage. Sexually active women may contract infectious diseases that involve the tube and ovary. a liver abscess.  Right-sided diverticulitis.

through small puncture wounds. laparoscopy is especially helpful in menstruating women in whom a rupture of an ovarian cyst may mimic appendicitis. This is done by freeing the appendix from its mesenteric attachment to the abdomen and colon. Wound infections are less common with laparoscopic surgery. How is an appendectomy done? During an appendectomy. the inflammation and infection of appendicitis are so severe that the surgeon will not close the incision at the end of the surgery because of concern that the wound is already infected. to severe. requiring only antibiotics. The appendix may be removed several weeks or months after the abscess has resolved.scan that can determine the exact location of the abscess. the surgical closing is postponed for several days to allow the infection to subside with antibiotic therapy and make it less likely for infection to occur within the incision. the surgeon may remove the appendix. Occasionally. Occasionally. requiring antibiotics and surgical treatment. particularly if peritonitis has occurred. the appendix is removed. . the patient generally is sent home from the hospital after surgery in one or two days. The reasoning in these cases is that it is better to remove a normal-appearing appendix than to miss and not treat appropriately an early or mild case of appendicitis. Instead. An additional advantage of laparoscopy is that it allows the surgeon to look inside the abdomen to make a clear diagnosis in cases in which the diagnosis of appendicitis is in doubt. of the surgical incision. the surgeon may find a normal-appearing appendix and no other cause for the patient's problem. that is. The laparoscope is a thin telescope attached to a video camera that allows the surgeon to inspect the inside of the abdomen through a small puncture wound (instead of a larger incision). Patients whose appendix has perforated are sicker than patients without perforation. After examining the area around the appendix to be certain that no additional problem is present. the pus can be drained with drains that pass from the abscess and out through the skin. The drain allows pus to flow from the abscess out of the body. The surgeon enters the abdomen and looks for the appendix which usually is in the right lower abdomen. Such infections vary in severity from mild. This is called an interval appendectomy and is done to prevent a second attack of appendicitis. to moderate. and their hospital stay often is prolonged (four to seven days). What are the complications of appendectomy? The most common complication of appendectomy is infection of the wound. an incision two to three inches in length is made through the skin and the layers of the abdominal wall over the area of the appendix. For example. If appendicitis is found. In this situation. If an abscess is present. just like the laparoscope. If the appendix is not ruptured (perforated) at the time of surgery. and sewing over the hole in the colon. with only redness and perhaps some tenderness over the incision. The abdominal incision then is closed. the appendix can be removed with special instruments that can be passed into the abdomen. Newer techniques for removing the appendix involve the use of the laparoscope. The benefits of the laparoscopic technique include less post-operative pain (since much of the post-surgery pain comes from incisions) and a speedier return to normal activities. cutting the appendix from the colon. Intravenous antibiotics are given in the hospital to fight infection and assist in resolving any abscess.

as previously discussed. Rather. Although abscesses can be drained of their pus surgically. That is. There are no major. especially recurrent symptoms. for example. et al. with stimuli other than inflammation. Original author and editor: Dennis Lee. the recurrent symptoms are not due to recurrent episodes of inflammation. 2008.D. prior inflammation has made the nerves of the intestines and appendix or the central nervous system that innervate them more sensitive to normal stimuli. hypothesis to confirm. . M. a collection of pus in the area of the appendix. Harrison's Principles of Internal Medicine. M.Crohn's disease. United States: McGraw-Hill Professional. and Jay W. 17th ed. What is new about appendicitis? Recently it has been hypothesized that some episodes of appendicitis-like symptoms. This will be a difficult. may be due to an increased sensitivity of the intestine and appendix from a prior episode of inflammation. Additional resources from WebMD Boots UK on Appendicitis REFERENCE: Fauci. long-term health problems resulting from removing the appendix although a slight increase in some diseases has been noted.D.. there are also non-surgical techniques. Anthony S.Another complication of appendectomy is an abscess. if not impossible. that is. Are there long-term consequences of appendectomy? It is not clear if the appendix has an important role in the body in older children and adults. Marks.

A complete contrast-filled appendix is observed (arrows). and the classic history of anorexia and periumbilical pain followed by nausea. Left untreated. However. No single sign. the deeper. which effectively excludes the diagnosis of appendicitis. appendicitis remains a clinical emergency and is one of the more common causes of acute abdominal pain. Go to Pediatric Appendicitis for more information on this topic. symptom. The emergency department (ED) clinician must evaluate the larger group of patients who present to the ED with abdominal pain of all etiologies with the goal of approaching 100% sensitivity for the diagnosis in a time-. The appendix appears during the fifth month of gestation. but the most important factor is the obstruction of the appendiceal lumen (see Pathogenesis and Etiology). including perforation or sepsis. Appendicitis may occur for several reasons. A normal appendix is seen below. and several lymphoid follicles are scattered in its Background Appendicitis is defined as an inflammation of the inner lining of the vermiform appendix that spreads to its other parts. has been called the vermiform appendix. and consultation-efficient manner. barium enema radiographic examination. or diagnostic test accurately confirms the diagnosis of appendiceal inflammation in all cases. right lower quadrant (RLQ) pain. The average length of the appendix is 8-10 cm (ranging from 2-20 cm). cost-. In fact. such as an infection of the appendix.[1] Appendectomy remains the only curative treatment of appendicitis (see Treatment and Management).http://emedicine. The surgeon's goals are to evaluate a relatively small population of patients referred for suspected appendicitis and to minimize the negative appendectomy rate without increasing the incidence of perforation. Beneath . and its exterior layer is longitudinal and derived from the taenia coli. The appendix is contained within the visceral peritoneum that forms the serosa. interior muscle layer is circular. and vomiting occurs in only 50% of cases (see Clinical Presentation). generous overlap with other clinical syndromes. which increases with diagnostic delay (see Clinical Presentation). Normal appendix. and may even cause death (see Prognosis and Complications). This condition is a common and urgent surgical illness with protean manifestations. and significant morbidity.medscape. Anatomy The appendix is a wormlike extension of the cecum and. the differential diagnosis of appendicitis is often a clinical challenge because appendicitis can mimic several abdominal conditions (see Diagnostic Considerations and Differentials). despite diagnostic and therapeutic advancement in medicine. appendicitis has the potential for severe complications. for this reason. Such follicles increase in number when individuals are aged 8-20 years.

leading to the recruitment of white blood cells (see the image below) and the formation of pus and subsequent higher intraluminal pressure. agenesis. within which courses the appendicular artery. Appendiceal vasculature The vasculature of the appendix must be addressed to avoid intraoperative hemorrhages. intestinal bacteria within the appendix multiply. The appendicular artery is contained within the mesenteric fold that arises from a peritoneal extension from the terminal ileum to the medial aspect of the cecum and appendix. appendiceal wall ischemia begins. At the same time. Appendiceal location The appendix has no fixed position. Thus. leading to venous outflow obstruction. Sometimes. intraluminal pressure rises ultimately above that of the appendiceal veins. The mucosa consists of columnar epithelium with few glandular elements and neuroendocrine argentaffin cells.these layers lies the submucosal layer. cecum. it is a terminal branch of the ileocolic artery and runs adjacent to the appendicular wall. and the difference in appendiceal position considerably changes clinical findings. in the pelvis. . directly beside the ileal orifice. duplication. Venous drainage is via the ileocolic veins and the right colic vein into the portal vein. Pathophysiology Reportedly. or liver. Congenital appendiceal disorders Appendiceal congenital disorders are extremely rare but occasionally reported (eg. which is the site of the appendiceal base. or behind the terminal ileum. accounting for the nonspecific signs and symptoms of appendicitis. ascending colon. It originates 1. If appendiceal obstruction persists. The appendix runs into a serosal sheet of the peritoneum called the mesoappendix. Technetium-99m radionuclide scan of the abdomen shows focal uptake of labeled WBCs in the right lower quadrant consistent with acute appendicitis. Such an increase is related to continuous secretion of fluids and mucus from the mucosa and the stagnation of this material. In fact. obstruction is believed to cause an increase in pressure within the lumen. appendicitis is caused by obstruction of the appendiceal lumen from a variety of causes (see Etiology). either in a dorsomedial location (most common) from the cecal fundus. an accessory appendicular artery (deriving from the posterior cecal artery) may be found. or as a funnel-shaped opening (2-3% of patients). As a consequence.7-2. Independent of the etiology. many individuals may have an appendix located in the retroperitoneal space.5 cm below the terminal ileum. The appendix has a retroperitoneal location in 65% of patients and may descend into the iliac fossa in 31%. the position of its tip. lymphatic drainage occurs via the ileocolic nodes along the course of the superior mesenteric artery to the celiac nodes and cisterna chyli. the course of the appendix. which is derived from the ileocolic artery. which contains lymphoepithelial tissue. resulting in a loss of epithelial integrity and allowing bacterial invasion of the appendiceal wall. triplication). Taenia coli converge on the posteromedial area of the cecum.

adenovirus. Histoplasma species). foreign material (eg. Dietary fiber is thought to decrease the viscosity of feces. neonatal and even prenatal appendicitis have been reported. The median age at appendectomy is 22 years. tuberculosis. Etiology Appendicitis is caused by obstruction of the appendiceal lumen. more rarely. which predispose individuals to obstructions of the appendiceal lumen. and tumors. representing 1 million patient-days of admission. activated charcoal). cytomegalovirus. Younger children have a higher rate of perforation. and it is one of the most common causes of abdominal pain. and discourage formation of fecaliths. actinomycosis. The most common causes of luminal obstruction include lymphoid hyperplasia secondary to inflammatory bowel disease (IBD) or infections (more common during childhood and in young adults). There is a slight male preponderance of 3:2 in teenagers and young adults. Prognosis Acute appendicitis is the most common reason for emergency abdominal surgery. parasites (especially in Eastern countries). and gradually declines in the geriatric years. Appendectomy carries a complication rate of 4-15%. In Asian and African countries. the goal of the surgeon is to make an accurate diagnosis as early as possible. Appendicitis occurs in 7% of the US population. with reported rates of 50-85%. a decrease in frequency of appendicitis in Western countries has been reported.000 cases of appendicitis are reported annually. gastroenteritis. which may be related to changes in dietary fiber intake. Lymphoid hyperplasia is associated with various inflammatory and infectious disorders including Crohn disease. decrease bowel transit time. Although rare.4 times greater in men than in women. In the United States. Some familial predisposition exists. Epidemiology Appendicitis is one of the more common surgical emergencies. Lymphoid hyperplasia is observed more often among infants and adults and is responsible for the increased incidence of appendicitis in these age groups. peaks in the late teen years. 250. fecal stasis and fecaliths (more common in elderly patients). Strongyloides stercoralis). the incidence of appendicitis is approximately 1. the higher incidence of appendicitis is believed to be related to poor fiber intake in such countries. amebiasis. tongue stud. The incidence of primary appendectomy is approximately equal in both sexes. this localized condition may worsen because of thrombosis of the appendicular artery and veins.Within a few hours. parasites (eg. The mean age when appendicitis occurs in the pediatric population is 6-10 years. The incidence of appendicitis gradually rises from birth. In fact. Go to Pediatric Appendicitis for more information on this topic. Clinicians must maintain a high index of suspicion in all age groups.1 cases per 1000 people per year. and the current annual incidence is 10 cases per 100. or. Fecaliths form when calcium salts and fecal debris become layered around a nidus of inspissated fecal material located within the appendix. as well as associated costs and the discomfort of hospitalization and surgery.000 population. a periappendicular abscess or peritonitis may occur. As this process continues. The incidence of acute appendicitis has been declining steadily since the late 1940s. with an incidence of 1. leading to perforation and gangrene of the appendix. shotgun pellet. pinworms. foreign bodies and neoplasms. intrauterine device. and mononucleosis.Mycobacteria species. In the last few years. Therefore. the incidence of acute appendicitis is probably lower because of the dietary habits of the inhabitants of these geographic areas. Schistosomesspecies. . The incidence of appendicitis is lower in cultures with a higher intake of dietary fiber. respiratory infections. in adults. Obstruction of the appendiceal lumen has less commonly been associated with bacteria (Yersinia species. measles.

the health care practitioner can narrow down the possible causes of the pain. The intensity and duration of pain must also be considered when making a diagnosis. lasting for a few minutes. The pain is often nonspecific and can be caused by a variety of conditions. diarrheal cramping. The mortality risk of acute but not gangrenous appendicitis is less than 0. Sometimes the pain is directly related to a specific organ such as the bladder or ovary. in patients older than 70 years. stabbing. . Abdominal Pain in Adults Overview Abdominal pain can range in intensity from a mild stomach ache to severe acute pain. better with a bowel movement. with a higher frequency occurring in younger age groups (40-57%) and in patients older than 50 years (55-70%). in whom misdiagnosis and delayed diagnosis are common. twisting. Softly pressing on certain areas to elicit the pain and perhaps palpating other areas to examine the size and exact location of an organ are other parts of the physical examination.1%. and postoperative wound infections account for almost one third of the associated morbidity.with examination of the abdomen. or worse when lying down. Usually. Once the questions and physical exam are completed. while other times it is more diffuse or non-specific.  Triggering Events: The pain may be worsened or relieved by certain events. The overall mortality rate of 0. the pain can be caused by appendicitis. the rate rises above 20%.2-0. This is done by combining questions such as .6% in gangrenous appendicitis. When this is combined with general questions about the pain such as "Is the pain dull or sharp?" "How long have you had the pain?" and questions about your state of health ."Did you have to vomit?" . where did you feel it?" . cramp-like. Complications occur in 15% of patients with appendicitis. Many organs are found within the abdominal cavity. knifelike. dull. A few general characteristics of abdominal pain are as follows:  Character of Pain: Abdominal pain can be sharp.Delayed diagnosis and treatment account for much of the mortality and morbidity associated with appendicitis. Sometimes abdominal pain comes on strongly for a while and then lessens in intensity for a while.1% to 1%. or piercing.  Duration of Pain: Abdominal pain can be brief.8% is attributable to complications of the disease rather than to surgical intervention. or it may persist for several hours and longer. and possibly Xrays and imaging studies to further help identify why the patient is in pain.. Or the pain can make them so restless they want to pace around trying to find "just the right position. primarily because of diagnostic and therapeutic delay. Appendiceal perforation is associated with increased morbidity and mortality compared with nonperforating appendicitis."When you first had the pain. The rate of perforation varies from 16% to 40%. or food poisoning. the health care practitioner will either give the patient a diagnosis and advise on follow-up recommendations or order blood tests. better after vomiting. Abdominal pain can make a person want to stay in one place and not move a muscle. such as worse after meals. Many other types of pain are possible. abdominal pain originates in the digestive system. The mortality rate in children ranges from 0." The health care practitioner will try to pinpoint the area of the abdomen where the pain originates when determining the cause of abdominal pain. but the risk rises to 0. The type and location of pain may help the physician find the cause. For example.

In some cases. no specific cause is determined. andpregnancy-associated problems.  Even some poisonings.  Certain skin rashes. and other diseases. Abdominal Pain in Adults Symptoms Abdominal pain is a symptom.  Doctors also worry about the following conditions: ruptured blood vessels. even though the person has nothing wrong inside their body. because this will help the health care practitioner's find the cause of the person's pain Pediatric Appendicitis Abdominal Pain in Adults Symptoms Abdominal pain is a symptom. gallbladder disease. Abdominal pain may not arise from the abdomen. .  Diseases people worry about most areappendicitis. Try to keep track of the symptoms. problems with the blood circulation to the intestine. can cause severe abdominal pain. From the above it is apparent that abdominal pain can have many causes. heart attack. can feel like abdominal pain. It may mean that the person has a medical problem that needs treatment. such as shingles. diverticulitis. It may mean that the person has a medical problem that needs treatment.  Some heart attacks and pneumonias can cause abdominal pain. such as a black widow spider bite. Sometime the cause of abdominal pain is not found by the patient's health care practitioner during the initial evaluation. infections.Abdominal Pain in Adults Causes Many acute (short-term) and chronic (long-term) diseases cause abdominal pain. duodenal and gastric ulcers.  Diseases of the pelvis or groin can also cause a pateint's abdomen to hurt. and the pain gets better in hours or days. some linked directly to the abdomen and others caused by non-abdominal disease. kidney stones. Abdominal pain may go along with other symptoms. liver and pancreas inflammation.

and inflammatory strictures. Although the base of the appendix is fixed to the cecum. The submucosa contains lymphoid follicles. obstruction usually results from lymphoid hyperplasia of the submucosal follicles. The location and extent of peritonitis (diffuse or localized) depends on the degree to which the omentum and adjacent bowel loops can contain the spillage of luminal contents. less than half that number is present. Another common cause of obstruction of the appendix is a fecalith. It arises from the cecum. because this will help the health care practitioner's find the cause of the person's pain. retrocecum. which are very few at birth. If the contents become walled off and form an abscess. and peritonitis develops. and the appendix becomes congested and ischemic. The incidence increases to 25 cases per 10.7%) and was found to increase with duration of symptoms. Anatomy The vermiform appendix is generally 5-10 cm in length.000 pediatric cases per year in the United States.000 children per year between 10 and 17 years of age. In children.[1] During the initial stage of appendicitis. The progression from obstruction to perforation usually takes place over 72 hours. bacteria trapped within the appendiceal lumen begin to multiply. 7% of people in the . The cause of this hyperplasia is controversial. Epidemiology Appendicitis has an incidence of 70. If the contents are not walled off and the fluid is able to travel throughout the peritoneum. which progresses to necrosis and gangrene. A substantial risk of perforation within 24 hours of onset was noted (7. but dehydration and viral infection have been proposed. Rare causes include foreign bodies. Etiology Acute appendicitis is due to obstruction of the blind ending appendix. resulting in a closed loop. Note that the anatomic position of the appendix determines the symptoms and the site of tenderness when the appendix becomes inflamed. a more intense and localized pain develops. When the appendix becomes gangrenous. than in adults. the patient feels only periumbilical pain due to the T10 innervation of the appendix. The combination of bacterial infection and ischemia produce inflammation. and the appendix becomes distended. This further inflames the peritoneal surface. nematodes). In persons older than 30 years. it may perforate. One study noted that appendiceal perforation is more common in children. the pain and tenderness may be localized to the abscess site.000 children per year. The increased intraluminal pressure obstructs venous drainage. Perforation results in the release of inflammatory fluid and bacteria into the abdominal cavity. The appendix is lined by typical colonic epithelium. the risk was associated more with prehospital delay than with in-hospital delay. While perforation was directly related to the duration of symptoms before surgery. Pathophysiology Once the appendix becomes obstructed. The incidence between birth and age 4 years is 1-2 cases per 10. As the inflammation worsens. an exudate forms on the appendiceal serosal surface.Abdominal pain may go along with other symptoms. parasitic infections (eg. This number gradually increases to a peak of about 200 follicles at age 10-20 years and then subsequently declines. Overall. the tip can be located in the pelvis. When the exudate touches the parietal peritoneum. specifically younger children. Try to keep track of the symptoms. the pain and tenderness become generalized. or extraperitoneum. and the number continues to decrease throughout adulthood. which in most children is located in the right lower quadrant of the abdomen.

[2] If the appendix perforates. followed by migration of pain to the right lower quadrant (RLQ) and onset of fever and vomiting. some patients deviate from the classic model. This pain is more intense. Death from appendicitis is most common in neonates and infants for the following 2 reasons:   Appendicitis is rare in this age group. Children with ruptured appendicitis are at risk for intra-abdominal abscess formation and small bowel obstruction.1-1%. A child who states that the ride to the hospital is painful when the vehicle hits bumps in the road may have peritoneal irritation. continuous. is observed in fewer than 60% of patients. Although the reason for this discrepancy is unknown. After a few hours. the patient’s only symptom is irritability or inconsolability. Acute onset of severe pain is not typical of acute appendicitis but is seen with acute ischemic conditions such as volvulus. In other patients. At the time of diagnosis. the rate of appendiceal perforation is 20-35%. While perforation was directly related to the duration of symptoms before surgery. or intussusception. Certain features of a child's presentation may suggest a perforated appendix. absence of both of these findings should place the diagnosis of appendicitis in question. A substantial risk of perforation within 24 hours of onset was noted (7. Appendicitis is much more common in developed countries. The child may have generalized abdominal pain and may have a temperature higher than 38°C. and the signs and symptoms localize to the rectum or bladder. thus.7%) in one study and was found to increase with duration of symptoms. an interval of pain relief is followed by development of generalized abdominal pain and peritonitis. Although some patients progress in the classical fashion.3 cases per 10. occurring at a rate of 23. although appendicitis occurs in adulthood and into old age. the prognosis is excellent. History The classic history of anorexia and vague periumbilical pain.United States have their appendix removed during their lifetime. Prognosis Generally. If the pain is initially located in the right lower quadrant. Appendicitis occurs in all age groups but is rare in infants. Thereafter. compared with 10-20% in children 10-17 years old. the risk was associated more with prehospital delay than with in-hospital delay. appendicitis is often low on the list of suspected differential diagnoses. Appendicitis is most common in the second decade of life (age 10-19 y). who constitute 15% of cases. Some neonates may not even become febrile.000 per year. In patients with a retrocecal appendix. testicular torsion. A child younger than 6 years with symptoms for more than 48 hours is much more likely to have a perforated appendix. Atypical presentations are common in neurologically impaired and immunocompromised patients. The male-to-female ratio is approximately 2:1. signs and symptoms may not localize to the RLQ but instead to the psoas muscle. This shift of pain rarely occurs in other abdominal conditions. . the tip of the appendix is deep in the pelvis. The mortality rate for children with appendicitis is 0. potential risk factors include a diet low in fiber and high in sugar. Often. unless the physician’s index of suspicion is high. the incidence continues to decline. Very young patients are unable to communicate the location and nature of their pain. and localized than the initial pain. and they can have a prolonged hospital stay (several weeks or more). and many have anorexia. as well as in children who are already on antibiotics for another illness. family history. severe constipation should be considered. and infection. ovarian torsion. the pain migrates to the RLQ due to inflammation of the parietal peritoneum. The rate of perforation is 80-100% for children younger than 3 years.[1] Pain All patients with appendicitis have abdominal pain.

This includes children who initially have localized pain and those with no visceral symptoms. in patients with retrocecal appendices. vomiting that occurs prior to pain is unusual. playing. Cardiac and pulmonary examination The findings on evaluation of the heart and lungs typically reflect the patient’s overall state more than they may suggest appendicitis. Because lower lobe pneumonias can cause abdominal findings. perhaps with the legs flexed. Pediatric patients have great physiological reserves and may not show any general symptoms until they are very ill. In patients with an appendix in a pelvic location. Abdominal examination . and walking around the room.Atypical pain is common and occurs in 40-45% of patients. vomiting and fever are more frequent findings in children with appendicitis than in children with other causes of abdominal pain. These patients often report diarrhea. particularly those that extend cephalad along the posterior surface of the right colon. Nausea and vomiting A unique feature of appendicitis is gradual onset of pain followed by vomiting. It is important to tailor the physical examination to the child's age and developmental stage. and the physician should consider other diagnoses. Generally. a history of such should be elicited and a thorough chest examination performed. However. such patients usually describe frequent. patience. and warm hands. According to one study. however. Pain on urination can be seen with pelvic appendicitis. General examination Patients’ general state and gait should be observed before interacting with them. Vomiting first is more typical of gastroenteritis. upon closer questioning. is much more a cause for concern than a child who is laughing. Diarrhea Significant diarrhea is atypical in appendicitis. other causes must be ruled out. Older children often seem uncomfortable or withdrawn. They may prefer to lie still because of peritoneal irritation. Patients are often dehydrated or in pain and may be tachycardic or tachypneic. Initial and continued observation of the child is of critical importance. However. Examination of the child requires skill. Children vary in their ability to cooperate with the physical examination. Physical Examination The physical examination findings in children may vary depending on age. inflammation of the appendix irritates the nearby duodenum. Teenaged patients often present in a classic or nearclassic fashion. and even then it may still be rare. A patient in obvious distress with abdominal pain gives the impression of an infectious process. Irritability may be the only sign of appendicitis in a neonate. The examination should be thorough and start with areas other than the abdomen. Severe fever is not a common presenting feature unless perforation has occurred. It is also important to exclude urinary tract infection (UTI) as a cause of abdominal pain. small-volume. An ill-appearing quiet child who is lying very still in bed. inflammation of the appendix occasionally results in an irritative stimulation of the rectum. Fever Most children with appendicitis are afebrile or have a low-grade fever and characteristic flushing of their cheeks. resulting in nausea and vomiting prior to the onset of RLQ pain. while not ruling out appendicitis. The patient’s state of activity or withdrawal may lend information into their condition. soft stools rather than true diarrhea.

The caliber of the patient's anus should be taken into consideration. A mass may be palpable in the RLQ if the appendix is perforated. Typically. Rectal examination The digital rectal examination is often deferred but can be helpful in establishing the correct diagnosis. Begin palpation of the abdomen at a site distant to this. searching for involuntary guarding of the rectus or oblique muscles. The patient should be told that the examination is uncomfortable but should not cause sharp pain. other acceptable maneuvers are tapping the patient's soles and shaking the stretcher. with the most tender area examined last. Distracting questions concerning school and family members may be helpful to relieve anxiety during the examination. Before examining the abdomen. If the child is particularly anxious. The rectal examination in a young child may have to be completely objective because . During the abdominal examination. This is a painful practice and certainly destroys any trust that has been garnered during the examination. Other methods can be used to establish that the patient has peritoneal irritation. A child with advanced appendicitis typically prefers to lie still due to peritoneal irritation. Palpation of the abdomen should be performed with a gentle and light touch. in whom the findings on the abdominal examination for appendicitis may be equivocal and indicative of peritoneal irritation. The rectal examination is particularly important in the child with a pelvic appendix. maximal tenderness can be found at the McBurney point in the RLQ. children may not have significant guarding or peritoneal signs. Objective information to ascertain includes impacted stool or an inflammatory mass. cough. jump up and down. Asking the patient to sit up in bed. Check for the obturator sign by internally rotating the flexed right thigh. and smaller digits should be used for examining younger patients. However. especially in sexually active adolescent girls. Observing the child's facial expressions during this questioning and palpating is critical. A positive response suggests an inflammatory mass overlying the obturator space (pelvic appendicitis). To assess for the psoas sign. place the child on the left side and hyperextend the right leg at the hip. Younger children are much more likely to present with diffuse abdominal pain and peritonitis. Peritonitis can be confirmed with gentle percussion over the right lower quadrant. ask the child to point with one finger to the site of maximal pain. palpation may be performed with a stethoscope. In early appendicitis. the appendix may lie in many positions. Patients with a retrocecal appendix may not have any tenderness until appendicitis is advanced or the appendix perforates. Right-sided tenderness of the rectum is the classic finding in patients with pelvic appendicitis or in those with pus that pools in the pelvis from an inflamed appendix elsewhere in the abdomen. Patients with a medially positioned appendix may present with suprapubic tenderness. A positive response suggests an inflammatory mass overlying the psoas muscle (retrocecal appendicitis). Patients with a laterally positioned appendix often have flank tenderness. Involuntary contraction of the abdominal wall musculature (involuntary guarding) and tenderness can be elicited with minimal stress or discomfort to the child.Full exposure of the abdomen is key. or bounce his or her pelvis off the bed while in the supine position may elicit pain in the presence of peritoneal irritation. try to avoid eliciting rebound tenderness. Alternatively. Presence of the Rovsing sign (pain in the RLQ in response to left-sided palpation or percussion) strongly suggests peritoneal irritation. Patients who are able to communicate should be asked if they have tenderness in different areas of the rectum. perhaps because their omentum is not well developed and cannot contain the perforation.

or discharge. appendicitis can develop as a sequela of gastroenteritis associated with lymphoid hyperplasia. Atypical findings Becker et al found that 44% of patients diagnosed with appendicitis presented with 6 or more of the following atypical features[3] :           No fever Absence of Rovsing sign Normal or increased bowel sounds No rebound pain No migration of pain No guarding Abrupt onset of pain No anorexia Absence of maximal pain in the RLQ Absence of percussive tenderness Diagnostic Considerations Do not diagnose gastroenteritis rather than appendicitis unless the patient has nausea. Appendicitis is rare in infants. bleeding.they may not be able to communicate variations in tenderness or may have general discomfort from the examination. vomiting. Other problems to consider include the following:         Ovarian cyst Ovarian torsion Pelvic inflammatory disease (PID) Pregnancy Ectopic pregnancy Renal calculi Mesenteric lymphadenitis Mittelschmerz . Even with the presence of vomiting and diarrhea. such as the immunocompromised and developmentally delayed. Pelvic examination A pelvic examination should be considered in sexually active adolescent girls to evaluate for tenderness (adnexal and/or cervical motion tenderness). Diagnose abdominal pain of unknown etiology in patients with nonspecific abdominal symptoms. If constipation is diagnosed and treated with enemas and/or stool softeners with resolution of the signs and symptoms. and diarrhea. Patients with equivocal examination findings should be admitted for observation for serial abdominal examinations or to undergo imaging with ultrasonography or abdominal CT scanning. consider the unusual presentations of retrocecal or pelvic appendicitis. Appendicitis should be considered in special patient populations. Instruct patients to be reevaluated in 8-12 hours by their primary care physician or to return to the emergency department. Genitourinary examination An external genitourinary (GU) examination is helpful to rule out testicular or scrotal tenderness in males and hematocolpos in pubertal girls. If an infant has appendicitis. the diagnosis ofHirschsprung disease should also be considered. inform the patient and family that recurrence of the abdominal pain in the future could be recurrent constipation or acute appendicitis and to seek medical advice. Additionally. masses.

       Pneumonia (right lower lobe) Neutropenic typhilitis Lymphoma Epiploic appendagitis Paratubal cysts Volvulus Typhlitis The major differential diagnoses for acute appendiceal abscess or mass include Crohn disease and malignancy. Ectopic Pyelonephritis Renal Calculi Testicular Torsion Urinary Tract Infection . Intussusception Pediatrics. Gastroenteritis Pediatrics. Urinary Tract Infections and Pyelonephritis Pelvic Inflammatory Disease Pregnancy Diagnosis Pregnancy. Differentials                   Constipation Ectopic Pregnancy Hemolytic-Uremic Syndrome Henoch-Schoenlein Purpura Meckel Diverticulum Ovarian Cysts Ovarian Torsion Pancreatitis Pediatrics.

Mucus created by the appendix travels through the appendiceal lumen and empties into the large intestine. Scientists are not sure what the appendix does. [Top] What is the appendix? The appendix is a fingerlike pouch attached to the large intestine and located in the lower right area of the abdomen. The appendix is a fingerlike pouch attached to the large intestine in the lower right area of the abdomen.http://digestive. National Institutes of Health (NIH What is appendicitis? Appendicitis is a painful swelling and infection of the National Digestive Diseases Information Clearinghouse (NDDIC) A service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). if anything. but removing it does not appear to affect a person's health. The inside of the appendix is called the appendiceal lumen. [Top] .nih.niddk.

Appendicitis leads to more emergency abdominal surgeries than any other cause. Bursting spreads infection throughout the abdomen—a potentially dangerous condition called peritonitis. Doctors may use laboratory and imaging tests to confirm appendicitis if a person does not have classic symptoms. often causing a person to wake up at night  occurs before other symptoms  begins near the belly button and then moves lower and to the right  is new and unlike any pain felt before  gets worse in a matter of hours  gets worse when moving around. the appendix swells and becomes infected. but it is more common among people 10 to 30 years old. [Top] What are the symptoms of appendicitis? Most people with appendicitis have classic symptoms that a doctor can easily identify. parasites. coughing. As a result. including  intestinal obstruction  inflammatory bowel disease  pelvic inflammatory disease and other gynecological disorders  intestinal adhesions  constipation [Top] How is appendicitis diagnosed? A doctor or other health care provider can diagnose most cases of appendicitis by taking a person's medical history and performing a physical examination. The main symptom of appendicitis is abdominal pain.What causes appendicitis? Obstruction of the appendiceal lumen causes appendicitis. Sources of obstruction include  feces. including Crohn's disease and ulcerative colitis  trauma to the abdomen An inflamed appendix will likely burst if not removed. The abdominal pain usually  occurs suddenly. caused by infection in the gastrointestinal tract or elsewhere in the body  inflammatory bowel disease. a doctor may suggest surgery right away to remove the appendix before it bursts. taking deep breaths. [Top] Who gets appendicitis? Anyone can get appendicitis. or sneezing Other symptoms of appendicitis may include  loss of appetite  nausea  vomiting  constipation or diarrhea  inability to pass gas  a low-grade fever that follows other symptoms  abdominal swelling  the feeling that passing stool will relieve discomfort Symptoms vary and can mimic other sources of abdominal pain. causing bacteria that normally live inside the appendix to multiply. or growths that clog the appendiceal lumen  enlarged lymph tissue in the wall of the appendix. Tests may also . Mucus backs up in the appendiceal lumen. If a person shows classic symptoms.

An abdominal x ray is rarely helpful in diagnosing appendicitis but can be used to look for other sources of abdominal pain. or illegal drugs. Women of childbearing age may be asked to undergo a pelvic exam to rule out gynecological conditions. which can be tender from appendicitis. which create cross-sectional images of the body. Knowing when other symptoms appeared relative to the pain is also helpful. A doctor can check for the psoas sign by applying resistance to the right knee as the patient tries to lift the right thigh while lying down. Imaging Tests Computerized tomography (CT) scans. The doctor will ask questions about other medical conditions. especially in people who are thin or young. The doctor will assess pain by touching or applying pressure to specific areas of the abdomen. The right psoas muscle runs over the pelvis near the appendix. Doctors may also order a pregnancy test for women. Guarding occurs when a person subconsciously tenses the abdominal muscles during an examination.  Rovsing's sign. The doctor may also examine the rectum. 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. Physical Examination Details about the abdominal pain are key to diagnosing appendicitis. Moving the bent knee left and right requires flexing the obturator muscle and will cause abdominal pain if the appendix is inflamed. Responses that may indicate appendicitis include  Guarding. A doctor tests for rebound tenderness by applying hand pressure to a patient's abdomen and then letting go. Medical History The doctor will ask specific questions about symptoms and health history. Answers to these questions will help rule out other conditions.  Psoas sign. alcohol. A person may also experience rebound tenderness as pain when the abdomen is jarred—for example. A doctor tests for the obturator sign by asking the patient to lie down with the right leg bent at the knee. A doctor tests for Rovsing's sign by applying hand pressure to the lower left side of the abdomen. can help diagnose appendicitis and other sources of abdominal pain. Pain felt upon the release of the pressure indicates rebound tenderness. when a person bumps into something or goes over a bump in a car.  Rebound tenderness. such as a high white blood cell count. Involuntary guarding occurs before the doctor actually makes contact. The right obturator muscle also runs near the appendix. Voluntary guarding occurs the moment the doctor's hand touches the abdomen. Women of . Urinalysis is used to rule out a urinary tract diagnose appendicitis in people who cannot adequately describe their symptoms. Laboratory Tests Blood tests are used to check for signs of infection. which sometimes cause abdominal pain similar to appendicitis.  Obturator sign. and use of medications. such as children or the mentally impaired. previous illnesses and surgeries. The doctor will want to know when the pain began and its exact location and severity. Flexing this muscle will cause abdominal pain if the appendix is inflamed. Blood tests may also show dehydration or fluid and electrolyte imbalances. Ultrasound is sometimes used to look for signs of appendicitis.

Surgery occasionally reveals a normal appendix. Ultrasound does not use radiation and is not harmful to a fetus. and has a shorter recovery time. [Top] How is appendicitis treated? Surgery Typically. surgery reveals a different problem. People who think they have appendicitis should see a doctor or go to the emergency room right away. Full recovery from surgery takes about 4 to 6 weeks. [Top] What should people do if they think they have appendicitis? Appendicitis is a medical emergency that requires immediate care. uses several smaller incisions and special surgical tools fed through the incisions to remove the appendix. surgery is performed to remove what remains of the burst appendix. exercise. or if the diagnosis is unclear. The drainage tube is left in place for about 2 weeks while antibiotics are given to treat infection. a tube is placed in the abscess through the abdominal wall. such as hospital-related infections. A soft diet is low in fiber and easily breaks down in the gastrointestinal tract. inability to pass gas. more commonly. The older method. nausea. or lifestyle. Some research suggests that appendicitis can get better without surgery. . Nonsurgical Treatment Nonsurgical treatment may be used if surgery is not available. removes the appendix through a single incision in the lower right area of the abdomen. Six to 8 weeks later. called laparotomy. CT is used to help find the abscess. appendicitis is treated by removing the appendix. Nonsurgical treatment includes antibiotics to treat infection and a liquid or soft diet until the infection subsides. Surgery to remove the appendix is called appendectomy and can be done two ways. Limiting physical activity during this time allows tissues to heal. drained before surgery. if a person is not well enough to undergo surgery. An abscess is a pus-filled mass that results from the body's attempt to keep an infection from spreading. [Top] Points to Remember    Appendicitis is a painful swelling and infection of the appendix. An abscess may be addressed during surgery or. Sometimes an abscess forms around a burst appendix—called an appendiceal abscess. vomiting. Occasionally. a doctor will often suggest surgery without conducting extensive diagnostic testing. low-grade fever. To drain an abscess. Prompt surgery decreases the likelihood the appendix will burst. constipation or diarrhea. when infection and inflammation are under control. Swift diagnosis and treatment reduce the chances the appendix will burst and improve recovery time. most people recover from appendicitis and do not need to make changes to diet. Symptoms of appendicitis may include abdominal pain.childbearing age should have a pregnancy test before undergoing x rays or CT scanning. The appendix is a fingerlike pouch attached to the large intestine and located in the lower right area of the abdomen. Recovery With adequate care. loss of appetite. Both use radiation and can be harmful to a developing fetus. The newer method. If appendicitis is suspected. called laparoscopic surgery. which may also be corrected during surgery. and abdominal swelling. In such cases. Laparoscopic surgery leads to fewer complications. many surgeons will remove the healthy appendix to eliminate the future possibility of appendicitis.

Participants in clinical trials can play a more active role in their own health care. KS 66207–1210 Phone: 1–800–274–2237 or 913–906–6000 Email: fp@aafp. [Top] For More Information American Academy of Family Physicians P. IL 60005 Phone: 847–290–9184 Fax: 847–290–9203 Email: American College of Surgeons 633 North Saint Clair Street Chicago. Appendicitis is a medical emergency that requires immediate care.   A doctor can diagnose most cases of appendicitis by taking a person's medical history and performing a physical examination.fascrs. visit www. [Top] Hope through Research The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducts and supports basic and clinical research into many digestive disorders.ClinicalTrials. For information about current studies. Box 11210 Shawnee Mission.aafp. IL 60611–3211 Phone: 1–800–621–4111 or 312–202–5000 Fax: 312–202–5001 Email: gain access to new research treatments before they are widely Internet: www. Sometimes laboratory and imaging tests are needed to confirm the American Society of Colon and Rectal Surgeons 85 West Algonquin Road. and help others by contributing to medical research. Suite 550 Arlington Internet: .org Internet: www. Appendicitis is typically treated by removing the appendix.

It has no known function. also called the colon. problems with blood flow and inflammation. tube-like organ attached to the first part of the large intestine. It is located in the lower right area of the abdomen.nlm. A blockage inside of the appendix causes appendicitis. Symptoms may include   Pain and/or swelling in the abdomen Loss of appetite  Nausea and vomiting  Constipation or diarrhea  Inability to pass gas  Low fever Not everyone with appendicitis has all these symptoms.html The appendix is a small. Anyone can get appendicitis. National Institute of Diabetes and Digestive and Kidney Diseases . It happens most often to people between the ages of 10 and 30. If the blockage is not the appendix can break open and leak infection into the body. Appendicitis is a medical emergency.http://www. Treatment almost always involves removing the appendix. The blockage leads to increased pressure.nih.