What Is Appendicitis?

Appendicitis occurs when the appendix, a small finger-shaped pouch attached to the large intestine, becomes inflamed or infected. This condition can cause painful symptoms such as stomach discomfort, nausea, vomiting, loss of appetite, and a mild fever.

A blockage in the appendix or an infection can cause appendicitis, and there is no known way to prevent the condition from occurring.  If you begin to experience symptoms, your healthcare provider can use a physical examination, imaging scans, and blood tests to give you an accurate diagnosis. In most cases, treatment involves antibiotics or surgery to remove the appendix. 

Approximately 250,000 people in the U.S. receive a diagnosis for appendicitis each year. While anyone can develop appendicitis, the condition is most common in people between 10 and 30 years old.

Types of Appendicitis 

There are two main types of appendicitis: acute and chronic (recurrent). Acute appendicitis is more common than chronic appendicitis.

• Acute appendicitis: Acute appendicitis occurs suddenly, with more severe symptoms that can worsen rapidly. This condition is considered a medical emergency that requires prompt treatment from a healthcare provider.
• Chronic appendicitis: Chronic appendicitis occurs when inflammation of the appendix persists over a long period, causing symptoms that come and go. This type of appendicitis is rare, accounting for only 1-5% of all appendicitis cases.

Symptoms 

Acute and chronic appendicitis symptoms are similar, but acute appendicitis comes on suddenly and quickly becomes more severe. With chronic (recurrent) appendicitis, symptoms tend to come and go and can range from mild discomfort to severe pain. 

Symptoms of appendicitis include:

• Abdominal pain: The tell-tale sign of appendicitis is abdominal (stomach) pain, which often begins as a dull ache near the belly button. Over hours or days, the pain becomes more severe and moves to the lower right portion of the abdomen. Taking a deep breath, walking, coughing, or applying pressure to the abdomen can worsen the pain. 
• Loss of appetite: Pain and discomfort, along with the body’s response to inflammation in the appendix, may reduce appetite and make you feel too unwell to eat. 
• Nausea and vomiting: After the onset of pain, nausea and vomiting can occur.
• Mild fever: A low-grade fever of 100 to 101 degrees Fahrenheit is a common symptom. A fever higher than this may signify that the appendix has ruptured.
• Changes in bowel movements: You might experience diarrhea and constipation, along with excess gas or the inability to pass gas.

Chronic appendicitis may also cause additional symptoms, such as fatigue, a general sense of feeling unwell, and bloating or abdominal swelling.

Causes  

Appendicitis occurs when the inside of the appendix (called the lumen) becomes inflamed or infected. Normally, the appendix produces mucus that travels through the lumen and into the large intestine. When the appendix becomes blocked, mucus backs up in the lumen and bacteria in the appendix begin to multiply. This causes the appendix to become inflamed, swollen, and infected, leading to the onset of appendicitis symptoms.

Some reasons appendix blockages occur include:

• Hard stool 
• Parasites
• Masses (tumors) 
• Infection in the gastrointestinal (GI) tract or other areas of the body
• Inflammatory bowel disease (e.g., Crohn’s disease or ulcerative colitis) 
• Abdominal injury 

Risk Factors 

Anyone can develop appendicitis, but certain risk factors can increase your risk of experiencing symptoms. Risk factors for appendicitis include:

• Age: Appendicitis is most common in people between the ages of 10 and 30
• Family history: Having family members with a history of appendicitis may raise your risk of developing symptoms
• Sex: People assigned male at birth have a slightly higher risk of getting appendicitis than those assigned female at birth
• Being immunocompromised: People who are undergoing chemotherapy, taking immunosuppressant medications, or have conditions that cause a weakened immune system are at an increased risk of experiencing symptoms

Diagnosis  

To diagnose appendicitis, your healthcare provider will likely perform a physical exam, ask about symptoms and medical history, and order one or more diagnostic tests. Generally, your provider may use one or more of the following diagnostic tests to rule out or confirm appendicitis:

• Medical history: Your doctor will ask about your symptoms, including when they began, where the pain is located, how severe symptoms are, and if any you've tried any at-home treatments. They will review your medical history, asking about your and your family members' current or past medical conditions, surgeries, and medications. 
• Physical examination: During the physical exam, your doctor will check your abdomen and ask how it feels as they put pressure on different areas of your stomach. They may also ask you to lift your leg while they press your right knee or flex and rotate your leg while you lie on your left side to determine if your appendix is the source of your pain. 
• Blood tests: Blood tests can measure certain biomarkers (e.g., white blood cells) that are associated with infection and inflammation in the body. 
• Urinalysis: Your provider may ask you to provide a urine sample to rule out other conditions, such as a urinary tract infection (UTI) or pregnancy. 
• Imaging scans: Imaging tests, such as an abdominal ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scan, can help your provider look for signs of inflammation or blockages in your organs.

Treatments 

The goal of treatment for appendicitis is to eliminate infection and inflammation in the appendix, which ultimately can improve symptoms. Your healthcare provider may recommend a variety of treatments, depending on the severity of your condition.

Antibiotics

Many providers choose to give antibiotics for people who may have appendicitis. For people with mild appendicitis, antibiotics alone may help clear up the infection, reduce inflammation, and eliminate symptoms. You can receive antibiotics intravenously (through an IV) when a healthcare provider or lab technician places a needle in your vein to administer the medicine.

Surgery

Currently, the gold standard treatment for appendicitis is surgery. The procedure is known as an appendectomy and your healthcare provider may recommend surgery if you have severe abdominal pain, an infection, or signs that your appendix has ruptured. There are two primary ways to perform an appendectomy:

• Open laparotomy: The surgeon will make an incision (cut) on the right side of the abdomen where the appendix is located to remove it.
• Laparoscopy: A minimally invasive (meaning, that very small cuts are made) surgical procedure in which small incisions are made to insert a laparoscope—a thin tube with a camera attached—to view and remove the appendix. 
  

How to Prevent Appendicitis 

There is no known way to prevent appendicitis, but some research suggests that eating a high-fiber diet may lower your risk. Though the reason for this is not fully understood, a fiber-rich diet is thought to help prevent constipation and reduce the risk of blockages in the appendix.  

Foods high in fiber include:

• Legumes and beans, such as lentils, peas, and black beans
• Berries, such as raspberries, strawberries, and blackberries
• Leafy green vegetables, such as kale, broccoli, and spinach 
• Whole grains, such as barley, oats, and popcorn 
• Nuts and seeds, such as pumpkin seeds, almonds, and flax seeds

Complications

If left untreated, appendicitis can cause the appendix to burst and lead to complications. Potential complications of a ruptured appendix include:

• Peritonitis: When the appendix ruptures, the contents from your appendix leak into the abdomen and cause an infection of the lining (called the peritoneum). 
• Abscess: An abscess is a collection of pus that can develop in your abdomen after the appendix ruptures. This can cause pain and discomfort and may require additional treatment, such as drainage of the pus or more antibiotics and other medications.
• Sepsis: A severe systemic infection (or, an infection that affects your whole body) can occur when your appendix ruptures and bacteria enter the bloodstream.

In rare cases, surgery to remove the appendix can lead to complications, such as: 

• Infection at the site of the surgical incision 
• Obstruction or blockage in the small intestine
• Fistula, which is an abnormal passageway or connection between the stomach or intestine and the skin 
  
• Ileus, a condition in which the intestine does not contract and function normally

Living With Appendicitis  

When treated promptly with surgery or antibiotics, most people with acute appendicitis fully recover and can return to normal activities within a few weeks. When left untreated, acute appendicitis can become potentially life-threatening, making early detection and treatment very important.

Chronic appendicitis can cause symptoms that come and go for years. In some cases, chronic appendicitis can become acute and require surgery to remove the appendix. Up to 23% of people who have had an appendectomy report symptoms of chronic appendicitis. If you have chronic appendicitis, it's a good idea to talk to your provider about additional treatment options to reduce long-term symptoms.

While this condition can be very painful and at times scary to undergo, it's critical to seek medical care if you or a loved one are displaying symptoms of appendicitis. Early treatment greatly improves the chances of recovery and reduces the risk of complications.