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Appendicitis

Causes and Symptoms

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Updated April 10, 2014

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.

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Causes of Appendicitis

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.

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Symptoms of Appendicitis

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.

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Material adapted from:
National Digestive Diseases Information Clearinghouse (NDDIC)
NIH Publication No. 04–4547 June 2004

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