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Appendicitis

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Appendicitis is the inflammation of the appendix, a small part of the digestive system.

Stomach colon rectum diagram-en
Stomach colon rectum diagram-en

It is one of the most common causes of sudden abdominal pain worldwide. This condition is a significant medical concern because it can lead to serious complications. If the inflammation is not treated, the appendix can rupture. A rupture releases bacteria into the abdominal cavity. This can cause peritonitis, which is widespread inflammation of the inner abdominal lining. It may also lead to sepsis, a very serious body-wide response to infection.

3D still showing appendicitis
3D still showing appendicitis

The process of appendicitis usually begins with a primary obstruction. This blockage occurs in the hollow portion, or lumen, of the appendix. The most common cause is a fecalith, which is a calcified stone made of feces.

X-ray showing fecalith which has caused appendicitis
X-ray showing fecalith which has caused appendicitis

Other causes include intestinal parasites, tumors, or inflamed lymphoid tissue from a viral infection. Once the appendix is blocked, it continues to produce mucus. This buildup increases the pressure within the appendix walls. This high pressure causes thrombosis, which is the blocking of small blood vessels. It also stops the flow of lymphatic fluid. As blood flow decreases, the tissue becomes ischemic, meaning it lacks oxygen. Eventually, the tissue becomes necrotic, or dies. Bacteria can then leak through the dying walls, leading to suppuration, or the formation of pus.

Histopathology of acute intraluminal inflammation of the appendix
Histopathology of acute intraluminal inflammation of the appendix

Symptoms of appendicitis can be categorized as typical or atypical. Typical cases often follow a specific pattern of pain. The pain may start as a dull ache around the navel. After several hours, the pain often migrates to the right lower quadrant.

McBurney's point
McBurney's point

This is known as Kocher's sign. As the appendix swells, it irritates the nearby abdominal wall. This causes the area to become very sensitive to pressure, a process called palpation. Other common symptoms include nausea, vomiting, fever, and anorexia, which is a loss of appetite. Interestingly, about 40% of people do not experience these typical symptoms. Atypical cases might present with pain in the right lower quadrant from the very beginning.

Doctors use several physical signs to help identify the condition during an exam. One example is Dunphy's sign, where coughing causes sharp pain in the right lower quadrant.

McBurney's point
McBurney's point

Another is the Psoas sign, where pain occurs when the person moves their right hip. Doctors also look for Blumberg's sign, which is pain felt when deep pressure on the abdomen is suddenly released. In some cases, the appendix may be retrocecal, meaning it sits behind the cecum. This position can make the appendix "silent" because the cecum protects it from pressure. If the appendix is located in the pelvis, a doctor might use a digital rectal examination to find tenderness. There are many such specialized signs used to detect the specific location of the inflammation.

To confirm a diagnosis, medical professionals use laboratory tests and imaging. A complete blood count (CBC) is a standard test to check for infection. Doctors look for an elevated white blood cell count, which indicates the body is fighting inflammation. The neutrophil-lymphocyte ratio can also be a very accurate indicator in children. For imaging, doctors often use ultrasound or computed tomography (CT) scans.

SonoAppendizitis
SonoAppendizitis
CAT scan demonstrating acute appendicitis
CAT scan demonstrating acute appendicitis

A CT scan is generally more accurate for detecting acute appendicitis. However, ultrasound is often the first choice for children and pregnant women. This is to avoid the risks of radiation exposure associated with CT scans. Ultrasound is also helpful for identifying other issues, such as ovarian pathology in females.

Treatment for acute appendicitis almost always involves surgery to remove the appendix. This procedure is called an appendectomy. Surgeons can perform an open surgery, known as a laparotomy, using a larger incision.

Apendixexternalview
Apendixexternalview

Alternatively, they may use laparoscopy, which is a minimally invasive technique. This method uses small incisions and a tiny camera to perform the removal.

While antibiotics may work for some non-ruptured cases, surgery is the standard to prevent death or complications. Statistics show that 31% of people treated with antibiotics for appendicitis will still need surgery within one year.

Appendicitis is a major global health issue with significant numbers. In 2015, approximately 11.6 million cases were reported worldwide. These cases resulted in about 50,100 deaths globally. In the United States, more than 300,000 people undergo an appendectomy every year. Research suggests a link between diet and the frequency of this condition. A transition to a Western diet that is lower in dietary fiber may be a factor. Higher fiber intake is thought to reduce the transit time of waste through the colon. This may help prevent the formation of the fecaliths that cause blockages.

Appendicitis world map-Deaths per million persons-WHO2012
Appendicitis world map-Deaths per million persons-WHO2012
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🖼️ Images & Media (21)
En.Wikipedia-VideoWiki-Appendicitis.webm
File:McBurney's point.jpg
McBurney's point.jpg
File:Stomach colon rectum diagram-en.svg
Stomach colon rectum diagram-en.svg
File:3D still showing appendicitis.jpg
3D still showing appendicitis.jpg
File:Appendicitis_(CT_angiogram)_(Radiopaedia_154713-127660_Axial_1).jpg
Appendicitis_(CT_angiogram)_(Radiopaedia_1...
File:SonoAppendizitis.JPG
SonoAppendizitis.JPG
File:CAT scan demonstrating acute appendicitis.jpg
CAT scan demonstrating acute appendicitis.jpg
File:X-ray showing fecalith which has caused appendicitis.jpg
X-ray showing fecalith which has caused...
File:AppendicolithPlainXray.png
AppendicolithPlainXray.png
File:Histopathology of acute intraluminal inflammation of the appendix.jpg
Histopathology of acute intraluminal...
File:Acute suppurative appendicitis with perforation.jpg
Acute suppurative appendicitis with...
File:Histopathology of necrotizing appendicitis, high magnification.jpg
Histopathology of necrotizing...

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