Appendicitis Overview

The appendix is a narrow tubular pouch attached to the intestines. When the appendix is blocked, it becomes inflamed and results in the condition known as appendicitis. If the blockage continues, the inflamed tissue becomes infected with bacteria and begins to die from a lack of blood supply, which finally results in the appendix bursting (perforated appendix).
Appendicitis is a common condition that affects 7% of the population, according to the American Academy of Family Physicians. Persons of any age may be affected, with the highest incidence occurring during the second and third decades of life. Rare cases of neonatal and prenatal appendicitis have been reported. Increased vigilance in recognizing and treating potential cases of appendicitis is required for the very young and old who have a higher rate of complications.

Appendicitis Causes
There is no clear cause of appendicitis. Fecal material is thought to be one possible obstructing object. Bacteria, viruses, fungi, and parasites can be responsible agents of an infection that leads to swelling of the tissues of the appendix wall, including Yersinia species, adenovirus, cytomegalovirus, actinomycosis, Mycobacteria species, Histoplasma species, Schistosoma species, pinworms, and Strongyloides stercoralis. Also, swelling of the tissue from inflammatory bowel diseases such as Crohn's disease may cause appendicitis. It appears that appendicitis is not hereditary or transmittable from person to person.

Appendicitis Symptoms
Appendicitis typically begins with a vague pain in the middle of the abdomen often near the navel or "belly button" (umbilicus). The pain slowly moves to the right lower abdomen (toward the right hip) over the next 24 hours. In the classic description, abdominal pain is accompanied with nausea, vomiting, lack of appetite, and fever. All of these symptoms, however, occur in fewer than half of people who develop appendicitis. More commonly, people with appendicitis have any combination of these symptoms.

* Symptoms of appendicitis may take 4-48 hours to develop. During this time, someone developing appendicitis may have varying degrees of loss of appetite, vomiting, and abdominal pain. Some may have constipation, diarrhea, or there may be no change in bowel habits.

* Early symptoms are often hard to separate from other conditions including gastroenteritis (an inflammation of the stomach and intestines). Many people admitted to the hospital for suspected appendicitis leave the hospital with a diagnosis of gastroenteritis; true appendicitis is often mis-diagnosed as gastroenteritis initially.

* Children and the elderly often have fewer symptoms, which makes their diagnosis less obvious and the incidence of complications more fre

When to Seek Medical Care
Call the doctor if there are acute symptoms of middle/lower or right/lower abdominal pain with fever and/or vomiting.

If symptoms of abdominal pain continue for more than four hours, an urgent medical evaluation should be done at the doctor's office or the hospital's emergency department
Exams and Tests

* Lab work: Although no blood test can confirm appendicitis, a blood sample is sent for laboratory analysis to check the white blood cell count, which is typically elevated in an individual with appendicitis. However, normal levels can be present with appendicitis, and elevated levels can be seen with other conditions. A urine test may be performed to exclude urinary tract infection (or pregnancy) as the cause of the symptoms.

* Imaging tests: Appendicitis is diagnosed by the classic symptoms and the physical exam (the doctor's examination of the patient's abdomen). Imaging tests are used when the diagnosis is not readily apparent. Most medical centers now use a CT scan of the abdomen and pelvis to help evaluate abdominal pain suspected of being caused by appendicitis. Ultrasound scanning is currently commonly used in small children to test for appendicitis.