Appendicitis

• What is Appendicitis
• Statistics on Appendicitis
• Risk Factors for Appendicitis
• Progression of Appendicitis
• Symptoms of Appendicitis
• Clinical Examination of Appendicitis
• How is Appendicitis Diagnosed?
• Prognosis of Appendicitis
• How is Appendicitis Treated?
• Appendicitis References

What is Appendicitis

Appendicitis is sudden onset of inflammation of the appendix, which is a small, finger-shaped blind-ending sac that branches off the first part of the large intestine (caecum).

Statistics on Appendicitis

Except for a hernia, acute appendicitis is the most common cause in the USA of an attack of severe, acute abdominal pain that requires abdominal operation.
The incidence of acute appendicitis is around 7% of the population in the United States and in European countries. In Asian and African countries, the incidence is probably lower because of the dietary habits of the inhabitants of these geographic areas.
Appendicitis occurs more frequently in men than in women, with a male-to-female ratio of 1.7:1. Appendicitis can effect any age but is more commom before 40 years of age, particularly in young people between 8 and 14 years. Rare cases of neonatal and prenatal appendicitis have been reported.

Risk Factors for Appendicitis

Appendicitis generally occurs following the obstruction of the appendix by faeces, another foreign body, or on rare occasions, a tumour. The first symptom is cramp like pain around the navel.
There is usually a marked decrease or total lack of appetite, often accompanied by nausea and occasionally, vomiting and fever.

Progression of Appendicitis

Appendicitis can sometimes be hard to diagnose as its symptoms vary widely between patients. However, typical symptoms and signs that suggest appendicitis is the sudden onset of central abdominal pain followed by nausea and vomiting.
After a few hours the pain then shifts to the right lower abdomen, and can be localised. The patient generally also has a low grade fever and will have a raised white blood cell count when blood tests are taken.

How is Appendicitis Diagnosed?

The doctor may investigate appendicitis by performing the following tests:

• A blood test called a full blood count or FBC (which counts all your cells in the blood), which would often show an increased white blood cell count;
• An abdominal x-ray;
• In cases where the diagnosis is uncertain, an ultrasound or CT of the abdomen may be useful.

Prognosis of Appendicitis

Appendicitis is a serious medical condition that needs urgent medical attention. If left untreated life-threatening peritonitis may develop.
With early surgery, the mortality rate is very low, the patient is usually discharged within a few days, and the recovery period is normally rapid and complete. With complications (such as rupture and either formation of an abscess or peritonitis), the prognosis is more serious; and although antibiotics have lowered mortality to nearly zero in many institutions, patients may need further surgery and therefore their recovery period will be longer.

How is Appendicitis Treated?

For definitive appendicitis, surgery (called an appendectomy or appendicectomy which removes the appendix) is performed as soon as possible after the diagnosis is made. Little preparation is required.
An appendectomy should be preceded by antibiotics, which are again given during the operation and continued during the early postoperative period. Suspected acute appendicitis should not be treated by antibiotics alone unless an operation is impossible.
In cases where the diagnosis of appendicitis is uncertain, hospital admission for a period of 12 to 24 hours for further observation may be undertaken. This time frame allows for the true clinical characterisitics of the illness to become evident.

Appendicitis References

1. Azaro EM, Amaral PC, Ettinger JE, et al. Laparoscopic versus open appendicectomy: A comparative study. JSLS. 1999;3(4):279-83. [Abstract | Full text]
2. Burkitt HG, Quick CRG. Essential Surgery: Problems, diagnosis and management (3rd edition). London: Churchill Livingstone; 2002. [Book]
3. Kraemer M, Franke C, Ohmann C, Yang Q. Acute appendicitis in late adulthood: Incidence, presentation, and outcome. Results of a prospective multicenter acute abdominal pain study and a review of the literature. Langenbecks Arch Surg. 2000;385(7):470-81. [Abstract]
4. Longmore M, Wilkinson I, Rajagopalan SR. Oxford Handbook of Clinical Medicine (6th edition). Oxford: Oxford University Press; 2004. [Book]
5. Morris PJ, Wood WC. Oxford Textbook of Surgery (2nd edition). Oxford: Oxford University Press; 2000. [Book]
6. Appendicitis [online]. Whitehouse Station, NJ: The Merck Manuals; 2004 [cited 7 November 2004]. Available from: URL link