Appendicitis is inflammation of the appendix. Symptoms commonly include lower right abdominal pain, nausea, vomiting, and decreased appetite. However, about 40% of people do not have these typical symptoms. Serious complications of a ruptured appendix include painful, generalized inflammation of the inner lining of the abdominal wall and sepsis.
Appendicitis is caused by a blockage of the hollow portion of the appendix. This is commonly due to a calcified "stone" made from stool. Inflamed lymphoid tissue from a viral infection, parasites, gallstones, or tumors can also cause the blockage. This blockage leads to increased pressures in the appendix, decreased blood flow to the appendix tissues, and bacterial growth within the appendix causing inflammation. The combination of inflammation, reduced blood flow to the appendix, and distention of the appendix causes tissue damage and tissue death. If this process is not treated, the appendix can burst, releasing bacteria into the abdominal cavity, leading to increased complications.
The diagnosis of appendicitis is based primarily on the person's signs and symptoms. In cases where the diagnosis is unclear, close observation, medical imaging, and laboratory tests can be helpful. The two most common imaging tests used are an ultrasound and a computed tomography (CT) scan. Computed tomography has been shown to be more accurate than ultrasound in detecting acute appendicitis. However, ultrasound may be preferred as the first imaging test in children and pregnant women because of the risks associated with radiation exposure from CT scans.
Acute appendicitis appears to be the end result of a primary obstruction of the appendix. Once this blockage occurs, the appendix fills with mucus and swells. This continual production of mucus leads to increased pressures within the lumen and walls of the appendix. Increased pressure causes thrombosis and occlusion of small vessels, and lymphatic flow stasis. At this point, spontaneous recovery rarely occurs.
The diagnosis is based on a medical history (symptoms) and a physical exam that can be supported by an elevation of neutrophil white blood cells and imaging studies if necessary. (Neutrophils are the primary white blood cells that respond to a bacterial infection.) Stories are divided into two categories, typical and atypical.
The treatment of appendicitis is surgical and urgent; The appendix is removed and the inflammation is removed (appendectomy). Only in patients with subacute appendicitis, which lasts longer without general involvement, surgery is usually performed later.
