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Appendicitis

Appendicitis is a condition in which your appendix gets inflamed. The appendix is a small pouch attached to the end of the large intestine.

Causes

Appendicitis is a very common reason for emergency surgery. The problem most often occurs when the appendix becomes blocked by feces, a foreign object, a tumor or a parasite in rare cases.

Symptoms

The symptoms of appendicitis can vary. It can be hard to detect appendicitis in young children, older people, and women of childbearing age.

The first symptom is often pain around the belly button or mid upper abdomen. Pain may be minor at first, but becomes more sharp and severe. You may also have a loss of appetite, nausea, vomiting, and a low-grade fever.

The pain tends to move into the right lower part of your belly. The pain tends to focus at a spot directly above the appendix called McBurney point. This most often occurs 12 to 24 hours after the illness starts.

Your pain may be worse when you walk, cough, or make sudden movements. Later symptoms include:

  • Chills and shaking
  • Hard stools
  • Diarrhea
  • Fever
  • Nausea and vomiting

Exams and Tests

Your health care provider may suspect appendicitis based on the symptoms you describe.

Your provider will do a physical exam.

  • If you have appendicitis, your pain will increase when your lower right belly area is pressed.
  • If your appendix has ruptured, touching the belly area may cause a lot of pain and lead you to tighten your muscles.
  • A rectal exam may find tenderness on the right side of your rectum.

A blood test will often show a high white blood cell count. Imaging tests that may help diagnose appendicitis include:

Treatment

Most of the time, a surgeon will remove your appendix as soon as you are diagnosed.

If a CT scan shows that you have an abscess, you may be treated with antibiotics first. You will have your appendix removed after the infection and swelling have gone away.

The tests used to diagnose appendicitis are not perfect. As a result, the operation may show that your appendix is normal. In that case, the surgeon will remove your appendix and explore the rest of your abdomen for other causes of your pain.

Outlook (Prognosis)

Most people recover quickly after surgery if the appendix is removed before it ruptures.

If your appendix ruptures before surgery, recovery may take longer. You are also more likely to develop problems, such as:

  • An abscess
  • Blockage of the intestine
  • Infection inside the abdomen (peritonitis)
  • Infection of the wound after surgery

When to Contact a Medical Professional

Contact your provider if you have pain in the lower-right portion of your belly, or other symptoms of appendicitis.

Open References

References

Carlberg DJ, Himelfarb NT. Acute appendicitis. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 79.

Garcia EM, Camacho MA, Karolyi DR, et al. ACR appropriateness criteria right lower quadrant pain -- suspected appendicitis. J Am Coll Radiol. 2018;15(11S):S373-S387. PMID: 30392606 pubmed.ncbi.nlm.nih.gov/30392606/.

Rosenthal MD, Sarosi GA. Appendicitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 120.

Sifri CD, Madoff LC. Appendicitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 78.

  • Appendectomy

    Animation

    •  

    Appendectomy - Animation

    Appendectomy, the removal of the small pouch attached to the beginning of your large intestine when you have an acute bout of appendicitis is one of the most common emergency abdominal surgeries. The appendix is a small, finger-shaped organ that comes out of the first part of the large intestine. It needs to be removed when it becomes swollen or infected. If the appendix is not removed, it can leak bacteria and infect your entire belly, which can be very life threatening. So, what are the signs that you have appendicitis? Well, this condition can be fairly hard to diagnose, especially in children, older people, and women of childbearing age. Usually, the first symptom is pain around your belly button. The pain might be mild at first, but then it gets sharp and severe before not too long. The pain may then move into your right lower abdomen. You may also have diarrhea, fever, nausea, and a reduced appetite. Sometimes, people think that they might be having food poisoning. Your doctor will make a diagnosis based on your symptoms. You may also have blood tests and a CT scan or ultrasound. Once it's clear that you have appendicitis, your doctor will probably schedule you for emergency surgery. In surgery, you will receive anesthesia and be asleep and pain free. The doctor will make a small cut in the lower right side of your belly and remove your appendix. If the surgeon uses the laparoscopic technique, you will have several small cuts in your abdomen for the surgical instruments. If your appendix broke open, or a pocket of infection has formed, your doctor will wash out your belly during the surgery. A small tube may remain to help drain out fluids or pus. Once you've had an appendectomy, you will probably recover pretty quickly. It feels good to get a bad appendix out. Most patients leave the hospital 1 to 2 days after surgery. The good news is that you'll be able to go back to all those normal activities within 2 to 4 weeks.

  • Anatomical landmarks adult - front

    Anatomical landmarks adult - front - illustration

    There are three body views (front, back, and side) that can help you to identify a specific body area. The labels show areas of the body which are identified either by anatomical or by common names. For example, the back of the knee is called the “popliteal fossa,” while the “flank” is an area on the side of the body.

    Anatomical landmarks adult - front

    illustration

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Appendectomy - series

    Appendectomy - series

    Presentation

    •  
  • Appendicitis

    Appendicitis - illustration

    The appendix is a small finger-shaped tube that branches off the first part of the large intestine. The appendix can become inflamed or infected causing pain in the lower right part of the abdomen.

    Appendicitis

    illustration

  • Appendectomy

    Animation

    •  

    Appendectomy - Animation

    Appendectomy, the removal of the small pouch attached to the beginning of your large intestine when you have an acute bout of appendicitis is one of the most common emergency abdominal surgeries. The appendix is a small, finger-shaped organ that comes out of the first part of the large intestine. It needs to be removed when it becomes swollen or infected. If the appendix is not removed, it can leak bacteria and infect your entire belly, which can be very life threatening. So, what are the signs that you have appendicitis? Well, this condition can be fairly hard to diagnose, especially in children, older people, and women of childbearing age. Usually, the first symptom is pain around your belly button. The pain might be mild at first, but then it gets sharp and severe before not too long. The pain may then move into your right lower abdomen. You may also have diarrhea, fever, nausea, and a reduced appetite. Sometimes, people think that they might be having food poisoning. Your doctor will make a diagnosis based on your symptoms. You may also have blood tests and a CT scan or ultrasound. Once it's clear that you have appendicitis, your doctor will probably schedule you for emergency surgery. In surgery, you will receive anesthesia and be asleep and pain free. The doctor will make a small cut in the lower right side of your belly and remove your appendix. If the surgeon uses the laparoscopic technique, you will have several small cuts in your abdomen for the surgical instruments. If your appendix broke open, or a pocket of infection has formed, your doctor will wash out your belly during the surgery. A small tube may remain to help drain out fluids or pus. Once you've had an appendectomy, you will probably recover pretty quickly. It feels good to get a bad appendix out. Most patients leave the hospital 1 to 2 days after surgery. The good news is that you'll be able to go back to all those normal activities within 2 to 4 weeks.

  • Anatomical landmarks adult - front

    Anatomical landmarks adult - front - illustration

    There are three body views (front, back, and side) that can help you to identify a specific body area. The labels show areas of the body which are identified either by anatomical or by common names. For example, the back of the knee is called the “popliteal fossa,” while the “flank” is an area on the side of the body.

    Anatomical landmarks adult - front

    illustration

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  •   Appendectomy - series

    Appendectomy - series

    Presentation

    •  
  • Appendicitis

    Appendicitis - illustration

    The appendix is a small finger-shaped tube that branches off the first part of the large intestine. The appendix can become inflamed or infected causing pain in the lower right part of the abdomen.

    Appendicitis

    illustration

 

Review Date: 5/2/2023

Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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