Pediatrics Articles

If we can live without it, why are we born with it? Good question! While research shows the appendix may work as part of the immune system, the question of exactly why we have an appendix and what function it serves is a mystery medical professionals are still trying to solve. But necessary or not, your appendix can be a real pain in your … well, side. 

The appendix is a tube or pouch of tissue that extends from the large intestine. Appendicitis is an inflammation of the appendix that can cause intense abdominal pain, especially on the right side where the appendix is located. Appendicitis is considered a medical emergency, and removal of the appendix is often necessary through a surgery called an appendectomy. 

What Are the Symptoms of Appendicitis?

The first sign of appendicitis is usually a dull pain that starts in the upper abdomen or near the belly button. The pain then becomes sharp as it moves to the lower right side of the abdomen. The location of the pain can be different based on the positioning of your appendix. For example, children can have a hard time pinpointing the pain on the right side. Pregnant women in particular often feel pain higher in the abdomen because the appendix is pressed into the upper abdomen as the uterus expands. Pain from appendicitis often gets worse if you make quick movements including running, walking, sneezing, or coughing. 

Those with appendicitis may also experience a loss of appetite, nausea or vomiting, fever, abdominal swelling, or difficulty passing gas. Sometimes vomiting occurs before the abdominal pain starts. Patients may also experience painful urination, severe cramps, constipation, or diarrhea. While sudden sharp pain in the lower right abdomen is considered a trademark of appendicitis, dull or sharp pain can occur anywhere in the abdomen, the back, or even the rectal area.

If you experience any of these symptoms, you should seek medical attention right away. Appendicitis can become life-threatening very quickly. Because of this risk, early diagnosis and treatment are key. Most cases of appendicitis are considered a medical emergency and given immediate medical attention, including the surgical removal of the appendix.

What Causes Appendix Pain?

The most common cause of appendicitis is a blockage in the lining of the appendix that results in inflammation and infection. The blockage is often caused by stool that gets trapped, but can also be a result of viruses, parasites, ulcers, or swelling due to an infection elsewhere in the body. When inflammation and swelling occur, pain is felt in the abdominal area. As bacteria multiply quickly in the appendix, it swells and fills with pus. If appendicitis is not treated right away, the appendix can rupture and spread infection into your abdominal cavity and throughout your body. This spread of infection is called peritonitis, is life-threatening, and requires emergency surgery to remove the appendix as well as clean out the abdomen to remove pus and prevent further infection. When your appendix ruptures, the pain becomes even more severe and typically spreads throughout the whole abdominal area.

How Is Appendicitis Diagnosed?

When symptoms of appendicitis appear, it is best to get medical attention right away. Your doctor will take note of your symptoms and access your abdominal pain. Your doctor will also likely examine the abdomen to detect signs of inflammation. There is no blood test for appendicitis, but blood tests are often used to determine white blood count and look for indicators of infection within the body. Other tests such as a urine test may be done to rule out additional conditions such as a urinary tract infection. If appendicitis is suspected, a CT scan or ultrasound of the appendix and surrounding abdominal area will often be done in order to confirm appendicitis and rule out other conditions or complications.

The symptoms of appendicitis can be vague and often change rapidly, making diagnosis difficult. Symptoms, especially stomach pain, are also easily confused with other conditions. Appendicitis can often present symptoms that are very similar to urinary tract infection, intestinal infection, diverticulosis, gallbladder issues, Crohn’s disease, ulcerative colitis, or problems with the ovaries.

Treatment Options for Appendicitis

If you suspect appendicitis, talk with a doctor right away. Common over-the-counter medications (such as pain relievers, antacids, and laxatives) to treat some of the symptoms can actually make the inflammation of the appendix worse and increase the risk of the appendix rupturing.

In some cases, antibiotics can work to treat and resolve appendicitis. However, since the risk of complications is high and the consequences are serious, most doctors don’t want to risk the chance that the appendix could rupture. In order to reduce the risk, doctors tend to treat all cases of acute appendicitis with surgical removal of the appendix through an appendectomy.

Stomach pain is common, so it can be tempting to just wait and see if it goes away. However, appendicitis does not get better with time. In fact, early diagnosis and treatment are important in order to avoid more serious problems. If there is a delay between the time your appendix ruptures and when you receive treatment, other complications can occur. An abscess can form in the abdomen, which makes surgery for removal of the appendix dangerous. It may require treatment with high doses of antibiotics first, and a procedure to drain the fluid from the abscess. Then a second surgery will be performed later for the actual removal of the appendix. 

What to Expect from Surgery

An appendectomy typically requires general anesthesia. The surgery to remove the appendix may be performed through open surgery, which involves an incision about four inches long. Open surgery is required if the appendix has already ruptured. However, laparoscopic surgery is more common in which small incisions are used to insert a small camera and surgical instruments. Laparoscopic appendectomy carries lower risk and requires a shorter amount of time for recovery and healing. Patients are typically able to move around within a few hours, and make a full recovery to their normal daily activities within two or three weeks.

Appendectomy is a common surgery, with good success rates. However, because of the risk of continued infection, there are important things to watch for as you are recovering. You should seek medical attention right away if your abdominal pain increases rather than decreasing. You should also contact your doctor or go to the closest ER if you feel dizzy, develop a fever, have uncontrolled vomiting, or notice blood in your vomit or urine. You should also watch your incision site carefully and see your doctor right away if there is increased redness, swelling or pain at the site of the incision, or if you notice pus in the wound. These can be signs of serious complications that need immediate medical attention.

Am I at Risk?

Appendicitis is very common, impacting about 1 in 20 people. It is most common in people ages 10-30 but is seen in people of all ages. Appendicitis is more common in males than females and is more likely to occur if you have a family history of it, but there is no way to accurately predict or prevent appendicitis. If you are experiencing the symptoms of appendicitis, visit your closest emergency department or call 911. 

If you need more information about stomach pain or have questions or concerns about your overall gastrointestinal health, request an appointment at GI Associates and Endoscopy Center today. We have three locations to serve you, and also specialize in pediatric gastrointestinal services.

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