The Appendix is a tube-like organ at the beginning of the large intestine. It measures about 7 to 15 cm long and 0.5 to 1.5cm wide. It is the tiniest part of the bowel; a worm-like out pouching at the junction where the small and large intestine meets, near the cecum. Its definite function is not fully known.
It was once wrongly thought to be a vestigial organ in humans, a remnant of "evolution". It is rare to find an appendix in other animals - only a very few species have it.
Current evidence suggests that the appendix is indeed a very important organ that helps in the immune functions of the bowel. It is believed to house "good bacteria" and releases these good bacteria into the bowel to aid the normal balance and function of gut from time to time.
The appendix is usually located on the right side of lower abdomen. In a few people with what is called situs invertus - a condition where all their organs are switched around to the opposite side of what is normal, the appendix can be located on the left side of their abdomen, and their heart on the right side, instead of the left. So if you are wondering where your appendix could be located, feel for your heart under your left breast, and if you can feel it, it then means that your appendix would be on the right lower abdomen - diagonally opposite your heart.
Appendicitis is the infection or inflammation (severe irritation) of the appendix. It is also called epityphilitis.
It is the most common cause of right lower abdominal pain of a few days duration, associated with loss of appetite, nausea, with or without constipation or diarrhea.
It is also the most common cause for emergency surgical admissions worldwide. About 70,000 operations are done in the UK yearly to remove a diseased appendix. In the US, it is reported that 1 in every ten persons would come down with an inflamed appendix. The incidence of this disease is falling in the industrialized world, but sharply rising in developing countries.
This condition is rare in infants, though it can occur at any age. It is one and a half times more common in men than in women. Women on the other hand are more likely to have unnecessary operation for a presumed appendicitis because of difficulties in differentiating this condition from other common causes of right lower abdominal pain in women.
Appendicitis in pregnancy is also a common phenomenon, though it tends to be less seen after the seventh month of pregnancy. It is very important to be able to diagnose this condition in a pregnant woman to avoid preventable complications. It is reported that as much as 10 percent (10 out of every 100) pregnant women who have appendicitis in pregnancy end up dying from this; 30 percent of cases of appendicitis in pregnancy end up with a miscarriage and fetal loss; while up to 60 % of appendicitis in pregnancy become perforated(1).
The symptoms of appendicitis are generally easy to spot in most people. It is a condition that commonly affects those between the ages of 10 and 30 years, though it can occur at any age.
The story is usually that of a vague or cramping central abdominal pain, around the umbilicus or navel. This pain is often ignored or thought to be due to indigestion or "tummy bug". Yes, the early stages of the pain of appendicitis can feel like heartburn.
Within a few hours or 2 to 3 days after the onset of the initial pain or discomfort, patients often report that their pain then move from around the belly button or umbilicus down to the right lower abdomen.
It is often at this point that most people give attention to the pain because it then becomes a more severe pain. There would be associated:
The above symptoms are the typical symptoms of appendicitis. The full picture described above is only seen in about 50% of patients with this condition.
Appendicitis does not last for days and weeks generally. It either continues to go bad with worsening symptoms until medical help is sought or gets better within a few days to a week or so.
If you suspect that you might be suffering with acute appendicitis, it is best you seek medical help as soon as possible.
The exact cause of appendicitis is not known.
The appendix, like the other parts of our intestine, has a lumen. On the wall of the lumen, there are some lymph nodes. The cells on the wall of the appendix also secret mucus to keep the appendix lubricated inside.
Appendicitis occurs when the lumen of the appendix becomes blocked for whatever reason and bugs (bacteria) then multiply inside the debris formed due to the blockade and infect the wall of the appendix.
Any blockage leads to a reduction in the blood supply to the part of the appendix below the level of the obstruction. Once the blood supply of any part of the body is reduced, bacteria tend to grow fast there, and colonize the dying tissue. This is understandable because the blood provides nutrients as well as regular supply of white blood cells which act to curtail infection.
So, what are the things that could cause blockage of the lumen of the appendix and cause appendicitis? They include:
Other causes of appendicitis that has been reported include:
Is appendicitis contagious? No Appendicitis is not spread by touching someone or coming in contact with an infection of any type.
There is no test or laboratory investigation or imaging technique that can be used to confirm the presence of an inflammation of the appendix with certainty at all times. Diagnosis of appendicitis is mainly based on a good history or story from the patient, a thorough physical examination of the patient and use of supportive blood test and scans, if deemed necessary.
The Alvarado Score scoring system for appendicitis is a very reliable way of predicting the presence of appendicitis. It adds up a number of common signs and symptoms of this condition, as well as laboratory findings to award a score of 0 to 10.
You can add up the presence or absence the symptoms and findings, and reach an Alvarado score as follows:
If you have a score of 1 to 4, appendicitis is unlikely, a score of 5-6 makes the presence of an inflamed appendix likely, a score of 7 to 8 means the diagnosis of this condition is most likely and a score of 9 to 10 makes this diagnosis almost certain.
The following are conditions that could cause symptoms similar to appendicitis and must be excluded to prevent unnecessary operation for a presumed inflammation of the appendix. They include:
The treatment of appendicitis is by means of surgery. This could be by the use of laparoscopy, also called keyhole surgery. This form of surgery is rapidly replacing open surgery for appendicitis. It is fast, save and has less complications.
Though often less favoured, with a risk of more complications, medical treatment of appendicitis can be undertaken in very special cases. This involves the use of antibiotic combination like a metronidazole and augmentin or cefuroxime intravenously for a few days.
Medical treatment of appendicitis can be adopted if:
The operation done to treat the inflammation of the appendix is called appendicectomy or appendectomy (in the US).
You can read more about the treatment of appendicitis here.
For insurance and billing purposes, the ICD 9 code for appendicitis, depending on the details of what you hope to be coding for are:
Are you suffering with a right sided abdominal pain? Do you suspect that this might be due to appendicitis? Or have you had your appendix removed? What was your experience like? Share your appendicitis stories here. We would really love to hear from you!
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minor could be serious?!
Hi-so its no biggie right now...yesterday morning at around 7am I woke up and was going to sleep in a few extra minutes but I felt a little pain on the …
Please help me this is extremely urgent
Okay so I woke up this morning about 6:00 am with a really sharp pain around my appendix... I never vomited, or had a fever today, anything. All I have …
Appendicitis 2years 4 months ago still problems bothering me
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pain in right lower quadrant with nausea and vomiting
pain in right lower quadrant with nausea and vomiting with movement. Area tender to touch. this has been ongoing since 4/18/11 . CT shows normal appendix. …
could this be appendicitis?
im 15. i had burger king on monday night, and woke up in the late night at about 3:30am with the most agonizing pain i've ever felt. i went pee and …
confused. Not rated yet
Hi... im enelia. i had a pain in my right lower abdomen, i felt it more about 3 consecutive days. Sometimes it is really painful when i moved but sometimes …