Professional Documents
Culture Documents
What is appendicitis?
Appendicitis is inflammation of the
appendix. Appendicitis is the leading cause
of emergency abdominal operations.1 Mouth
organs.
2 Appendicitis
How is appendicitis Responses that may indicate appendicitis
include
diagnosed?
A health care provider can diagnose most Rovsings sign. A health care provider
cases of appendicitis by taking a persons tests for Rovsings sign by applying hand
medical history and performing a physical pressure to the lower left side of the
exam. abdomen. Pain felt on the lower right
side of the abdomen upon the release
If a person does not have the usual of pressure on the left side indicates the
symptoms, health care providers may use presence of Rovsings sign.
laboratory and imaging tests to confirm
appendicitis. These tests also may help Psoas sign. The right psoas muscle
diagnose appendicitis in people who cannot runs over the pelvis near the appendix.
adequately describe their symptoms, such Flexing this muscle will cause abdominal
as children or people who are mentally pain if the appendix is inflamed. A
impaired. health care provider can check for the
psoas sign by applying resistance to the
Medical History right knee as the patient tries to lift the
right thigh while lying down.
The health care provider will ask specific
questions about symptoms and health Obturator sign. The right obturator
history. Answers to these questions will help muscle also runs near the appendix.
rule out other conditions. The health care A health care provider tests for the
provider will want to know obturator sign by asking the patient to
lie down with the right leg bent at the
when the abdominal pain began
knee. Moving the bent knee left and
the exact location and severity of the right requires flexing the obturator
pain muscle and will cause abdominal pain if
the appendix is inflamed.
when other symptoms appeared
Guarding. Guarding occurs when
other medical conditions, previous
3 Appendicitis
Rebound tenderness. A health care or sent to a laboratory for analysis.
provider tests for rebound tenderness Urinalysis is used to rule out a urinary
by applying hand pressure to a persons tract infection or a kidney stone.
lower right abdomen and then letting
Pregnancy test. Health care providers
go. Pain felt upon the release of the
also may order a pregnancy test for
pressure indicates rebound tenderness
women, which can be done through a
and is a sign the appendix is inflamed.
blood or urine test.
A person may also experience rebound
tenderness as pain when the abdomen Imaging Tests
is jarredfor example, when a person
Imaging tests can confirm the diagnosis
bumps into something or goes over a
of appendicitis or find other causes of
bump in a car.
abdominal pain.
Women of childbearing age may be asked
Abdominal ultrasound. Ultrasound
to undergo a pelvic exam to rule out
uses a device, called a transducer,
gynecological conditions, which sometimes
that bounces safe, painless sound
cause abdominal pain similar to appendicitis.
waves off organs to create an image
The health care provider also may examine of their structure. The transducer
the rectum, which can be tender from can be moved to different angles to
appendicitis. make it possible to examine different
organs. In abdominal ultrasound, the
Laboratory Tests health care provider applies gel to the
Laboratory tests can help confirm the patients abdomen and moves a hand
diagnosis of appendicitis or find other causes held transducer over the skin. The gel
of abdominal pain. allows the transducer to glide easily,
and it improves the transmission of the
Blood tests. A blood test involves signals. The procedure is performed
drawing a persons blood at a health in a health care providers office,
care providers office or a commercial an outpatient center, or a hospital
facility and sending the sample to a by a specially trained technician,
laboratory for analysis. Blood tests can and the images are interpreted by a
show signs of infection, such as a high radiologista doctor who specializes
white blood cell count. Blood tests in medical imaging; anesthesia is not
also may show dehydration or fluid and needed. Abdominal ultrasound creates
electrolyte imbalances. Electrolytes are images of the appendix and can show
chemicals in the body fluids, including signs of inflammation, a burst appendix,
sodium, potassium, magnesium, and a blockage in the appendiceal lumen,
chloride. and other sources of abdominal pain.
Urinalysis. Urinalysis is testing of Ultrasound is the first imaging test
a urine sample. The urine sample performed for suspected appendicitis
is collected in a special container in infants, children, young adults, and
in a health care providers office, a pregnant women.
commercial facility, or a hospital and
can be tested in the same location
4 Appendicitis
Magnetic resonance imaging (MRI). interpreted by a radiologist; anesthesia
MRI machines use radio waves and is not needed. Children may be given
magnets to produce detailed pictures a sedative to help them fall asleep for
of the bodys internal organs and the test. A CT scan of the abdomen
soft tissues without using x rays. The can show signs of inflammation,
procedure is performed in an outpatient such as an enlarged appendix or an
center or a hospital by a specially abscessa pus-filled mass that results
trained technician, and the images are from the bodys attempt to keep an
interpreted by a radiologist. Anesthesia infection from spreadingand other
is not needed, though children and sources of abdominal pain, such as
people with a fear of confined spaces a burst appendix and a blockage in
may receive light sedation, taken by the appendiceal lumen. Women
mouth. An MRI may include the of childbearing age should have a
injection of special dye, called contrast pregnancy test before undergoing
medium. With most MRI machines, a CT scan. The radiation used
the person lies on a table that slides in CT scans can be harmful to a
into a tunnel-shaped device that may be developing fetus.
open ended or closed at one end; some
machines are designed to allow the How is appendicitis treated?
person to lie in a more open space. An
Appendicitis is typically treated with surgery
MRI can show signs of inflammation,
to remove the appendix. The surgery is
a burst appendix, a blockage in the
performed in a hospital; general anesthesia
appendiceal lumen, and other sources
is needed. If appendicitis is suspected,
of abdominal pain. An MRI used
especially in patients who have persistent
to diagnose appendicitis and other
abdominal pain and fever, or signs of a
sources of abdominal pain is a safe,
burst appendix and infection, a health care
reliable alternative to a computerized
provider will often suggest surgery without
tomography (CT) scan.2
conducting diagnostic testing. Prompt
CT scan. CT scans use a combination surgery decreases the chance that the
of x rays and computer technology to appendix will burst.
create three-dimensional (3-D) images.
For a CT scan, the person may be given Surgery to remove the appendix is called
a solution to drink and an injection of an appendectomy. A surgeon performs the
contrast medium. CT scans require the surgery using one of the following methods:
person to lie on a table that slides into Laparotomy. Laparotomy removes the
a tunnel-shaped device where the x rays appendix through a single incision in the
are taken. The procedure is performed lower right area of the abdomen.
in an outpatient center or a hospital by
an x-ray technician, and the images are Laparoscopic surgery. Laparoscopic
surgery uses several smaller incisions
and special surgical tools fed through
the incisions to remove the appendix.
2Heverhagen J, Pfestroff K, Heverhagen A, Klose
Laparoscopic surgery leads to fewer
K, Kessler K, Sitter H. Diagnostic accuracy complications, such as hospital-related
of magnetic resonance imaging: a prospective
evaluation of patients with suspected appendicitis infections, and has a shorter recovery
(diamond). Journal of Magnetic Resonance Imaging. time.
2012;35:617623.
5 Appendicitis
With adequate care, most people recover Can appendicitis be treated
from appendicitis and do not need to
make changes to diet, exercise, or lifestyle.
without surgery?
Surgeons recommend limiting physical Nonsurgical treatment may be used if
activity for the first 10 to 14 days after a surgery is not available, a person is not well
laparotomy and for the first 3 to 5 days after enough to undergo surgery, or the diagnosis
laparoscopic surgery. is unclear. Nonsurgical treatment includes
antibiotics to treat infection.
What are the complications
and treatment of a burst What should people do
appendix? if they think they have
A burst appendix spreads infection
appendicitis?
throughout the abdomena potentially Appendicitis is a medical emergency that
dangerous condition called peritonitis. A requires immediate care. People who think
person with peritonitis may be extremely they have appendicitis should see a health
ill and have nausea, vomiting, fever, and care provider or go to the emergency room
severe abdominal tenderness. This condition right away. Swift diagnosis and treatment
requires immediate surgery through can reduce the chances the appendix will
laparotomy to clean the abdominal cavity burst and improve recovery time.
and remove the appendix. Without prompt
treatment, peritonitis can cause death. Eating, Diet, and Nutrition
Sometimes an abscess forms around a burst Researchers have not found that eating,
appendixcalled an appendiceal abscess. A diet, and nutrition play a role in causing or
surgeon may drain the pus from the abscess preventing appendicitis. If a health care
during surgery or, more commonly, before provider prescribes nonsurgical treatment for
surgery. To drain an abscess, a tube is a person with appendicitis, the person will be
placed in the abscess through the abdominal asked to follow a liquid or soft diet until the
wall. The drainage tube is left in place for infection subsides. A soft diet is low in fiber
about 2 weeks while antibiotics are given and is easily digested in the GI tract. A soft
to treat infection. Six to 8 weeks later, diet includes foods such as milk, fruit juices,
when infection and inflammation are under eggs, puddings, strained soups, rice, ground
control, surgeons operate to remove what meats, fish, and mashed, boiled, or baked
remains of the burst appendix. potatoes. People can talk with their health
care provider to discuss dietary changes.
What if the surgeon finds a
normal appendix?
Occasionally, a surgeon finds a normal
appendix. In this case, many surgeons will
remove it to eliminate the future possibility
of appendicitis. Occasionally, surgeons
find a different problem, which may also be
corrected during surgery.
6 Appendicitis
Points to Remember Hope through Research
Appendicitis is inflammation of the
The National Institute of Diabetes and
appendix.
Digestive and Kidney Diseases (NIDDK)
and other components of the National
The appendix is a fingerlike pouch
Institutes of Health (NIH) conduct and
attached to the large intestine and
support basic and clinical research into many
located in the lower right area of the
digestive disorders, including appendicitis.
abdomen. The inside of the appendix is
called the appendiceal lumen. Clinical trials are research studies involving
An obstruction, or blockage, of the people. Clinical trials look at safe and
appendiceal lumen causes appendicitis. effective new ways to prevent, detect, or
treat disease. Researchers also use clinical
The most common symptom of trials to look at other aspects of care, such
appendicitis is abdominal pain. Other as improving the quality of life for people
symptoms of appendicitis may include with chronic illnesses. To learn more about
loss of appetite, nausea, vomiting, clinical trials, why they matter, and how to
constipation, diarrhea, an inability to participate, visit the NIH Clinical Research
pass gas, a low-grade fever, abdominal Trials and You website at www.nih.gov/health/
swelling, and the feeling that passing clinicaltrials. For information about current
stool will relieve discomfort. studies, visit www.ClinicalTrials.gov.
A health care provider can diagnose
most cases of appendicitis by taking a For More Information
persons medical history and performing
American Academy of Family Physicians
a physical exam. If a person does not
P.O. Box 11210
have the usual symptoms, health care
Shawnee Mission, KS 662071210
providers may use laboratory and
Phone: 18002742237 or 9139066000
imaging tests to confirm appendicitis.
Email: contactcenter@aafp.org
Appendicitis is typically treated with
Internet: www.aafp.org
surgery to remove the appendix.
7 Appendicitis
Acknowledgments National Digestive Diseases
Publications produced by the Clearinghouse Information Clearinghouse
are carefully reviewed by both NIDDK 2 Information Way
scientists and outside experts. This Bethesda, MD 208923570
publication was originally reviewed by Jason Phone: 18008915389
A. Brodsky, M.D., Shady Grove Adventist TTY: 18665691162
Hospital, Rockville, MD. Fax: 7037384929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov
You may also find additional information about this
topic by visiting MedlinePlus at www.medlineplus.gov. The National Digestive Diseases Information
This publication may contain information about Clearinghouse (NDDIC) is a service of the
medications and, when taken as prescribed, National Institute of Diabetes and Digestive
the conditions they treat. When prepared, this
publication included the most current information and Kidney Diseases (NIDDK). The
available. For updates or for questions about NIDDK is part of the National Institutes of
any medications, contact the U.S. Food and Drug
Administration toll-free at 1888INFOFDA
Health of the U.S. Department of Health
(18884636332) or visit www.fda.gov. Consult your and Human Services. Established in 1980,
health care provider for more information. the Clearinghouse provides information
about digestive diseases to people with
digestive disorders and to their families,
health care professionals, and the public.
The NDDIC answers inquiries, develops and
distributes publications, and works closely
with professional and patient organizations
and Government agencies to coordinate
resources about digestive diseases.