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During our operating room exposure, an appendectomy was one of the most common surgical procedures done. This procedure would only last for about one and a half to two hours. A local surgeon even said in an article he wrote that “an appendectomy is basically a simple straight to the point operation, the bread and butter of all general surgeons. It is so simple they say even a monkey can do it.”

So what really is an appendectomy? An appendectomy is the removal of the appendix. Usually, an appendectomy is done when there is appendicitis.

Appendicitis is the inflammation of the appendix. This can be caused by something trapped in the appendix, such as: a piece of dried stool, a piece of food, tumors, scar tissue, worms, barium after a diagnostic exam or overgrowth of the lymph tissue of the appendix. The first sign of appendicitis is usually a pain or discomfort in the center of the abdomen. This discomfort is often thought at first to be a simple stomach upset. After a few hours, the pain becomes more noticeable and constant in the lower right part of the stomach. The patient often loses their appetite, feels sick, and vomits. The temperature is raised and the complexion becomes flushed. Once it starts, there is no effective medical therapy, so appendicitis is considered a medical emergency. When treated promptly, most patients recover without difficulty. If treatment is delayed, the appendix can burst, causing infection and even death.
The most serious complication of appendicitis is rupture. The appendix bursts or tears if appendicitis is not diagnosed quickly and goes untreated. Infants, young children, and older adults are at highest risk. A ruptured appendix can lead to peritonitis and abscess. Peritonitis is a dangerous infection that happens when bacteria and other contents of the torn appendix leak into the abdomen. In people with appendicitis, an abscess usually takes the form of a swollen mass filled with fluid and bacteria. In a few patients, complications of appendicitis can lead to organ failure and death.

            this is what happened to our patient Annalyn Intos. She was diagnosed with a ruptured appendix.
The symptoms can be extremely variable but often take the following classic pattern. The first sign is usually a pain or discomfort in the centre of the abdomen. This pain comes and goes in waves and is often thought at first to be a simple stomach upset.

After a few hours, the pain becomes more noticeable and constant in the lower right part of the stomach. It is increased by movement or coughing. The patient often loses their appetite, feels sick, and vomits. The temperature is raised and the complexion becomes flushed. The breath may smell offensive.
This can be caused by something trapped in the appendix, such as:

• A piece of dried stool
  
• A piece of food
  
• Tumors
  
• Scar tissue
  
• Worms
  
• Barium after a diagnostic exam
  
• Overgrowth of the lymph tissue of the appendix
  

The appendix, according to a surgical book, appears to have no clear function.
The first operation a first year surgical resident is allowed to do is an appendectomy. It is basically a simple straight to the point operation. Taking out someone's appendix. The bread and butter of all general surgeons. It is so simple they say even a monkey can do it.
It's not always clear why appendicitis occurs. Sometimes it's the result of an obstruction when food waste or a hard piece of stool (fecal stone) becomes trapped in an orifice of the cavity that runs the length of your appendix.
Appendicitis may also follow an infection, such as a gastrointestinal viral infection, or it may result from other types of inflammation. In both cases, bacteria may subsequently invade rapidly, causing the appendix to become inflamed and filled with pus. If not treated promptly, your appendix eventually may rupture
Definition
Appendicitis is inflammation of the appendix. The appendix is a small, tube-like organ that hangs from the intestines. It appears to have no clear function.
Appendicitis

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Causes
Appendicitis usually occurs when the appendix becomes inflamed. This can be caused by something trapped in the appendix, such as:

• A piece of dried stool
  
• A piece of food
  
• Tumors
  
• Scar tissue
  
• Worms
  
• Barium after a diagnostic exam
  
• Overgrowth of the lymph tissue of the appendix
  

The lining of the appendix continues to produce mucus, but it has no place to go. Bacteria normally found in the intestines grow and produce toxins in the lining of the appendix. Pressure builds and causes severe pain in the abdomen. The wall of the appendix can break open. If the appendix ruptures, its contents can spill into the abdominal cavity. This causes serious inflammation in the abdominal cavity called peritonitis, which can be fatal.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.

• Sex: Male
  
• Age: Teen years
  
• Family members who have had appendicitis
  

Symptoms
Symptoms usually come on suddenly. Pain generally increases during a 6- to 12-hour period. Patients may experience some or all of the following symptoms:

• Pain
  
• Starts as discomfort around the belly button
  
• Usually moves to the right side of the abdomen over several hours
  
• May be in a different location if the appendix is not in the usual place
  
• Increases as inflammation in the appendix builds
  
• Worsens with sneezing, coughing, and deep breathing
  
• May increase with movement
  
• Loss of appetite
  
• Nausea
  
• Vomiting
  
• Swelling of the abdomen
  
• Abdomen feels hard and is sensitive to touch
  
• Constipation
  
• Mild diarrhea
  
• Slight fever
  

If the appendix ruptures, symptoms include:

• Pain becoming stronger and spreading across the abdomen
  
• Increasing fever
  

Note: Symptoms may be atypical in infants, children, pregnant women, and the elderly.
Diagnosis
Seek immediate medical care if you have severe pain in the abdomen. Appendicitis can be hard to diagnose. Symptoms vary and can be similar to symptoms of other diseases.
The doctor will ask about your symptoms and medical history, and perform a physical exam. The exam will include:

• Carefully touching the abdomen and observing your body's reactions
  
• A rectal exam
  

Other tests to determine the cause of your pain may include:

• Blood Tests – to see if you have an infection
  
• Urine Tests – to rule out a urinary tract infection
  
• CT Scan or Ultrasound – to look for signs of an inflamed appendix or abscess that may be causing the pain. These tests are only helpful in cases of late appendicitis.
  
• Laparoscopy – looking at the appendix through a thin, lighted tube inserted through a small incision near the belly button
  

Treatment
Appendicitis is treated by surgically removing the appendix as soon as possible. If the diagnosis is not certain, the doctor may carefully monitor your condition for 6 to 12 hours before operating. You will also be given antibiotics to fight infection.
Prevention
There are no guidelines for preventing appendicitis because it comes on suddenly and the cause is usually not known. To decrease the risk of rupture, seek medical care immediately for severe abdominal pain.
RESOURCES:
American College of Surgeons
http://www.facs.org
National Digestive Diseases Information Clearinghouse
http://digestive.niddk.nih.gov/index.htm
REFERENCES:
American College of Surgeons website. Available at: http://www.facs.org/. Accessed October 13, 2005.
Dambro MR. Griffith's 5-Minute Clinical Consult, 1999 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.
Diagnosis of appendicitis in emergency departments. Am Fam Physician. 2003 Jun 1;67(11):2390.
Emergency Medicine: Concepts and Clinical Practice, 4th ed. Philadelphia, PA: Mosby-Year Book, Inc.; 1998.
Feldman M, Scharschmidt BF, Sleisenger MHSleisenger and Fordtran's Gastrointestinal and Liver Disease, 6th ed. Philadelphia, PA: W. B. Saunders Company; 1998.
JAMA patient page: appendicitisJAMA. 1999;282:1102.
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/. Accessed October 13, 2005.
Sabiston, DC Jr. Textbook of Surgery, 15th ed. Philadelphia, PA: W. B. Saunders Co.; 1997.

 

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Last reviewed September 2005 by Jill Landis, MD
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Home : Digestive Diseases A-Z List of Topics and Titles : Appendicitis   Appendicitis Causes Symptoms Diagnosis Treatment Complications Points to Remember Hope Through Research For More Information The appendix is a small, tube-like structure attached to the first part of the large intestine, also called the colon. The appendix is located in the lower right portion of the abdomen. It has no known function. Removal of the appendix appears to cause no change in digestive function. Appendicitis is an inflammation of the appendix. Once it starts, there is no effective medical therapy, so appendicitis is considered a medical emergency. When treated promptly, most patients recover without difficulty. If treatment is delayed, the appendix can burst, causing infection and even death. Appendicitis is the most common acute surgical emergency of the abdomen. Anyone can get appendicitis, but it occurs most often between the ages of 10 and 30. The appendix is a small, tube-like structure attached to the first part of the large intestine, also called the colon. The appendix is located in the lower right portion of the abdomen, near where the small intestine attaches to the large intestine. [Top] Causes The cause of appendicitis relates to blockage of the inside of the appendix, known as the lumen. The blockage leads to increased pressure, impaired blood flow, and inflammation. If the blockage is not treated, gangrene and rupture (breaking or tearing) of the appendix can result. Most commonly, feces blocks the inside of the appendix. Also, bacterial or viral infections in the digestive tract can lead to swelling of lymph nodes, which squeeze the appendix and cause obstruction. This swelling of lymph nodes is known as lymphoid hyperplasia. Traumatic injury to the abdomen may lead to appendicitis in a small number of people. Genetics may be a factor in others. For example, appendicitis that runs in families may result from a genetic variant that predisposes a person to obstruction of the appendiceal lumen. [Top] Symptoms Symptoms of appendicitis may include pain in the abdomen, first around the belly button, then moving to the lower right area loss of appetite nausea vomiting constipation or diarrhea inability to pass gas low fever that begins after other symptoms abdominal swelling Not everyone with appendicitis has all the symptoms. The pain intensifies and worsens when moving, taking deep breaths, coughing, or sneezing. The area becomes very tender. People may have a sensation called "downward urge," also known as "tenesmus," which is the feeling that a bowel movement will relieve their discomfort. Laxatives and pain medications should not be taken in this situation. Anyone with these symptoms needs to see a qualified physician immediately. People With Special Concerns Patients with special conditions may not have the set of symptoms above and may simply experience a general feeling of being unwell. Patients with these conditions include people who use immunosuppressive therapy such as steroids people who have received a transplanted organ people infected with the HIV virus people with diabetes people who have cancer or who are receiving chemotherapy obese people Pregnant women, infants and young children, and the elderly have particular issues. Abdominal pain, nausea, and vomiting are more common during pregnancy and may or may not be the signs of appendicitis. Many women who develop appendicitis during pregnancy do not experience the classic symptoms. Pregnant women who experience pain on the right side of the abdomen need to contact a doctor. Women in their third trimester are most at risk. Infants and young children cannot communicate their pain history to parents or doctors. Without a clear history, doctors must rely on a physical exam and less specific symptoms, such as vomiting and fatigue. Toddlers with appendicitis sometimes have trouble eating and may seem unusually sleepy. Children may have constipation, but may also have small stools that contain mucus. Symptoms vary widely among children. If you think your child has appendicitis, contact a doctor immediately. Older patients tend to have more medical problems than young patients. The elderly often experience less fever and less severe abdominal pain than other patients do. Many older adults do not know that they have a serious problem until the appendix is close to rupturing. A slight fever and abdominal pain on one's right side are reasons to call a doctor right away. All patients with special concerns and their families need to be particularly alert to a change in normal functioning and patients should see their doctors sooner, rather than later, when a change occurs. [Top] Diagnosis Medical History and Physical Examination Asking questions to learn the history of symptoms and a careful physical examination are key in the diagnosis of appendicitis. The doctor will ask many questions—much like a reporter—trying to understand the nature, timing, location, pattern, and severity of pain and symptoms. Any previous medical conditions and surgeries, family history, medications, and allergies are important information to the doctor. Use of alcohol, tobacco, and any other drugs should also be mentioned. This information is considered confidential and cannot be shared without the permission of the patient. Before beginning a physical examination, a nurse or doctor will usually measure vital signs: temperature, pulse rate, breathing rate, and blood pressure. Usually the physical examination proceeds from head to toe. Many conditions such as pneumonia or heart disease can cause abdominal pain. Generalized symptoms such as fever, rash, or swelling of the lymph nodes may point to diseases that wouldn't require surgery. Examination of the abdomen helps narrow the diagnosis. Location of the pain and tenderness is important. Pain is a symptom described by a patient; tenderness is the response to being touched. Two signs, called peritoneal signs, suggest that the lining of the abdomen is inflamed and surgery may be needed: rebound tenderness and guarding. Rebound tenderness is when the doctor presses on a part of the abdomen and the patient feels more tenderness when the pressure is released than when it is applied. Guarding refers to the tensing of muscles in response to touch. The doctor may also move the patient's legs to test for pain on flexion of the hip (psoas sign), pain on internal rotation of the hip (obturator sign), or pain on the right side when pressing on the left (Rovsing's sign). These are valuable indicators of inflammation but not all patients have them. Laboratory Tests Blood tests are used to check for signs of infection, such as a high white blood cell count. Blood chemistries may also show dehydration or fluid and electrolyte disorders. Urinalysis is used to rule out a urinary tract infection. Doctors may also order a pregnancy test for women of childbearing age (those who have regular periods). Imaging Tests X rays, ultrasound, and computed tomography (CT) scans can produce images of the abdomen. Plain x rays can show signs of obstruction, perforation (a hole), foreign bodies, and in rare cases, an appendicolith, which is hardened stool in the appendix. Ultrasound may show appendiceal inflammation and can diagnose gall bladder disease and pregnancy. By far the most common test used, however, is the CT scan. This test provides a series of cross-sectional images of the body and can identify many abdominal conditions and facilitate diagnosis when the clinical impression is in doubt. All women of childbearing age should have a pregnancy test before undergoing any testing with x rays. In selected cases, particularly in women when the cause of the symptoms may be either the appendix or an inflamed ovary or fallopian tube, laparoscopy may be necessary. This procedure avoids radiation, but requires general anesthesia. A laparoscope is a thin tube with a camera attached that is inserted into the body through a small cut, allowing doctors to see the internal organs. Surgery can then be performed laparoscopically if the condition present requires it. [Top] Treatment Surgery Acute appendicitis is treated by surgery to remove the appendix. The operation may be performed through a standard small incision in the right lower part of the abdomen, or it may be performed using a laparoscope, which requires three to four smaller incisions. If other conditions are suspected in addition to appendicitis, they may be identified using laparoscopy. In some patients, laparoscopy is preferable to open surgery because the incision is smaller, recovery time is quicker, and less pain medication is required. The appendix is almost always removed, even if it is found to be normal. With complete removal, any later episodes of pain will not be attributed to appendicitis. Recovery from appendectomy takes a few weeks. Doctors usually prescribe pain medication and ask patients to limit physical activity. Recovery from laparoscopic appendectomy is generally faster, but limiting strenuous activity may still be necessary for 4 to 6 weeks after surgery. Most people treated for appendicitis recover excellently and rarely need to make any changes in their diet, exercise, or lifestyle. Antibiotics and Other Treatments If the diagnosis is uncertain, people may be watched and sometimes treated with antibiotics. This approach is taken when the doctor suspects that the patient's symptoms may have a nonsurgical or medically treatable cause. If the cause of the pain is infectious, symptoms resolve with intravenous antibiotics and intravenous fluids. In general, however, appendicitis cannot be treated with antibiotics alone and will require surgery. Occasionally the body is able to control an appendiceal perforation by forming an abscess. An abscess occurs when an infection is walled off in one part of the body. The doctor may choose to drain the abscess and leave the drain in the abscess cavity for several weeks. An appendectomy may be scheduled after the abscess is drained. [Top] Complications The most serious complication of appendicitis is rupture. The appendix bursts or tears if appendicitis is not diagnosed quickly and goes untreated. Infants, young children, and older adults are at highest risk. A ruptured appendix can lead to peritonitis and abscess. Peritonitis is a dangerous infection that happens when bacteria and other contents of the torn appendix leak into the abdomen. In people with appendicitis, an abscess usually takes the form of a swollen mass filled with fluid and bacteria. In a few patients, complications of appendicitis can lead to organ failure and death. [Top] Points to Remember The appendix is a small, tube-like structure attached to the first part of the colon. Appendicitis is an inflammation of the appendix. Appendicitis is considered a medical emergency. Symptoms of appendicitis include pain in the abdomen, loss of appetite, nausea, vomiting, constipation or diarrhea, inability to pass gas, low-grade fever, and abdominal swelling. Not everyone with appendicitis has all the symptoms. Physical examination, laboratory tests, and imaging tests are used to diagnose appendicitis. Acute appendicitis is treated by surgery to remove the appendix. The most serious complication of appendicitis is rupture, which can lead to peritonitis and abscess. [Top] Hope Through Research The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducts and supports research into many kinds of digestive disorders, including some related to appendicitis. [Top] For More Information American Academy of Family Physicians P.O. Box 11210 Shawnee Mission, KS 66207–1210 Phone: 1–800–274–2237 Email: fp@aafp.org Internet: www.aafp.org American College of Surgeons 633 North Saint Clair Street Chicago, IL 60611–3211 Phone: 312–202–5000 Fax: 312–202–5001 Email: postmaster@facs.org Internet: www.facs.org American Society of Colon and Rectal Surgeons (ASCRS) 85 West Algonquin Road Suite 550 Arlington Heights, IL 60005 Phone: 847–290–9184 Fax: 847–290–9203 Email: ascrs@fascrs.org Internet: www.fascrs.org National Library of Medicine—MEDLINEplus Internet: www.nlm.nih.gov/medlineplus [Top] National Digestive Diseases Information Clearinghouse 2 Information Way Bethesda, MD 20892–3570 Email: nddic@info.niddk.nih.gov The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1980, 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. Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet was reviewed by Joshua Katz, M.D., George Washington University Medical Center. This publication is not copyrighted. The Clearinghouse encourages users of this fact sheet to duplicate and distribute as many copies as desired. NIH Publication No. 04–4547 June 2004 [Top]

  

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