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Medical News Today: Appendicitis: Warning Signs and Early Symptoms

MNT Knowledge Center

Appendicitis is a condition in which the appendix becomes inflamed. Its symptoms can become very uncomfortable, painful, and potentially life-threatening if left untreated.

Sudden appendicitis is the most common cause of acute abdominal pain requiring surgery in the United States. Additionally, more than 5 percent of the population develops appendicitis at some point.

Though it most commonly occurs between the ages of 10 and 30, appendicitis can develop at any age.

Symptoms of appendicitis

Appendicitis should be treated as soon as symptoms appear. This will prevent it from worsening and causing further complications.

Stomach pain is usually the first symptom of appendicitis. The National Institute of Diabetes and Digestive and Kidney Diseases describe the pain as a severe type “different from any pain you’ve felt before.” The pain can be sudden and come about without warning.

A woman has abdominal pain.
Severe pain is often the first symptom of appendicitis. In most cases, it will begin near the belly button.

The pain will often begin near the belly button. As it worsens, the pain will likely shift to the lower right side of the abdomen. The feeling may become more intense within the next few hours and be worsened by moving around, taking deep breaths, coughing, or sneezing.

The following are also classic symptoms of appendicitis:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Constipation or diarrhea
  • Inability to pass gas
  • Low-grade fever and chills
  • A temperature between 99-102°F
  • Stomach swelling
  • Wanting to have a bowel movement to relieve discomfort

The classic appendicitis symptoms appear in only 50 percent of those who develop the condition.

Some patients may experience classic symptoms like stomach pain very slightly or not at all. Others may have less common appendicitis symptoms.

Symptoms in children and infants

Children and infants may not experience pain in one specific area. Tenderness may be spread through the body or even be absent altogether.

Also, children and infants may have less frequent bowel movements, if at all. Diarrhea can be a symptom of another illness. Children and infants may not experience as precise pain as older patients. However, research suggests that stomach pain is still the most common appendicitis symptom for them.

Symptoms in older adults and pregnant women

Older adults and pregnant women may also experience different appendicitis symptoms. The stomach pain may not be as severe for these patients, nor as specific.

For pregnant women, stomach pain may shift upward toward the upper right quadrant after the first trimester. They may also have some back or flank pain.

In both groups, people should look for the less common symptoms of appendicitis. These include nausea, vomiting, and fever. Stomach pain can often be caused by another condition.

Other conditions with similar symptoms

Stomach pain can be a symptom of other conditions that may incorrectly seem like appendicitis. According to the National Institute of Diabetes and Digestive and Kidney Diseases, the following conditions also commonly cause stomach pain:

  • Stomach lesions
  • Constipation
  • Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis
  • Stool, parasites, or growths that clog the inside of the appendix
  • Damage or injury to the abdomen

When to see a doctor

Appendicitis is a potentially life-threatening condition and requires immediate medical care. The condition will very likely worsen the longer it is left untreated. Medical professionals recommend going to the emergency room as soon as symptoms begin so that a doctor can diagnose and treat appendicitis.

What is the appendix?

Image of the appendix.
The appendix is a tube-shaped piece of tissue attached to part of the long intestine.

The appendix is a tube-shaped piece of tissue that is closed at one end. It is attached to the cecum, a pouch-like portion of the colon, or large intestine.

It generally measures about 4 inches long and is situated on the right, lower side of the abdomen.

The appendix has been known to be a nonfunctioning organ, unnecessary for survival. However, a study published in the Journal of Theoretical Biology suggests it may serve a purpose.

Researchers from Duke University Medical Center in Durham, NC, believe that the appendix may play a role in maintaining a healthy immune system.

They say that the appendix helps create good germs to help our bodies protect other good germs and fight off bad ones.

Diagnosis of appendicitis

Typically, a healthcare provider will diagnose appendicitis by doing the following:

Reviewing the symptoms

The patient will be asked to provide details about what symptoms they are experiencing, how severely, and for how long.

Reviewing the patient’s medical history

To rule out other potential health issues, the doctor will want to know details about the patient’s medical history. These details include:

  • Any other medical conditions or surgeries the patient has or has had in the past
  • Whether the patient takes any medications or supplements
  • Whether the patient drinks alcohol or takes any recreational drugs

Doing a physical exam

The doctor will do a physical exam to find out more about the patient’s stomach pain and diagnose appendicitis accurately. They will apply pressure to or touch certain areas of the abdomen. Pelvic and rectal exams may also be used.

Ordering lab tests

The doctor will order lab tests to help confirm an appendicitis diagnosis or detect signs of other health issues. Blood and urine tests are commonly required. Doctors may also ask for blood or urine samples to check for pregnancy.

If they find it necessary to confirm the diagnosis, the doctor may also order following imaging tests. The tests may include an abdominal ultrasound, MRI exam, or CT scan.

These imaging tests can show the following sources of stomach pain:

  • An enlarged or burst appendix
  • Inflammation
  • A blockage inside the appendix
  • Abscesses

Treatment for appendicitis

Appendectomy surgery.
Surgery may be needed to treat a case of appendicitis.

Treating appendicitis normally begins with antibiotics and adding fluids to the veins. Some mild cases of appendicitis can be treated completely with fluids and antibiotics.

The most common next step for treating appendicitis is surgery. The procedure is called an appendectomy. Removing the appendix decreases the risk of it rupturing. Treating appendicitis early is also important to reduce the risk of complications, which can lead to death.

There are two types of surgery involved with appendectomy:

Laparoscopic surgery

  • Surgeons make several small incisions and use special tools to remove the appendix through them
  • Laparoscopic surgery can lead to fewer complications, such as hospital-related infections
  • Recovery time is generally shorter
  • Doctors recommend that patients limit their physical exercise for the first 3 to 5 days after surgery

Laparotomy surgery

  • Surgeons remove the appendix through a single incision made in the lower right area of the abdomen
  • Laparotomy surgery may be required for a burst appendix
  • It allows the surgeon to clean the inside of the abdomen to prevent infection
  • Doctors recommend patients limit their physical activity for the first 10 to 14 days after a laparotomy surgery

Risk factors that make appendicitis worse

Delay in treatment can greatly increase the risk of complications with appendicitis. Inflammation can cause the appendix to rupture, sometimes as soon as 48 to 72 hours once the symptoms begin.

A rupture can cause bacteria, stool, and air to leak into the abdomen. This can subsequently cause infection and further complications, which can be fatal.

Taking pain medications can potentially mask symptoms and delay treatment.

Written by Foram Mehta

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