Updated: January 9, 2018
Appendicitis is inflammation of the appendix. It is a medical emergency that requires prompt surgery to remove the appendix. An inflamed appendix will eventually burst or perforate resulting in spilling infectious materials into the abdominal cavity if left untreated. This can lead to serious inflammation of the lining of abdominal cavity known as peritonitis.
This can be fatal unless it is treated quickly with strong antibiotics.
It can be difficult to diagnose appendicitis as the position of the appendix in the abdomen may vary. Most of the time the appendix is in the right lower abdomen. But sometimes the appendix may be longer than normal. If it has a large mesentery, the combination of a large mesentery and a long appendix results in the movement of the appendix to dip down into the pelvis. It may also allow the appendix to move behind the colon which is called a retro-colic appendix . In either case, inflammation of the appendix may appear to be more like the inflammation of pelvic organs.
The symptoms of appendicitis may be similar to other health issue, including gallbladder problems, bladder or urinary tract infection, Crohn's disease, gastritis, intestinal infection, and ovary problems. Therefore the diagnosis of appendicitis begins with a thorough history and physical examination of the patient. The following tests are usually used to help make the diagnosis:
Usually the patients will have a high temperature, and moderate to severe tenderness in the right lower abdomen. If inflammation has spread to the peritoneum, rebound tenderness will be there which is pain that is worse when the doctor gently press on the abdomen over the area of tenderness and quickly releases his or her hand.
A CBC test can determine if there is a bacterial infection which is often correlated with appendicitis. A blood test can be done to look for elevated white blood cell count. Usually it becomes elevated with infection. Almost any infection or inflammation can cause the count to be elevated. Therefore, an elevated white blood cell count alone cannot be used to confirm a diagnosis of appendicitis.
Urinalysis is a microscopic examination of the urine that detects red blood cells, white blood cells and bacteria in the urine. When there is inflammation or stones in the kidneys or bladder, the test will be abnormal. As the appendix lies near the ureter and bladder, the inflammation can spread to the ureter and bladder leading to an abnormal urinalysis.
A normal urinalysis rule out a urinary tract infection and kidney stone than detecting an appendicitis as most patients with appendicitis will have normal result.
A number of imaging test can be done to diagnose appendicitis which include:
An abdominal x-ray may detect the fecalith that blocks the appendiceal opening causing appendicitis. The presence of a fecalith can occur without appendicitis also which especially happens in children.
Ultrasound can identify an enlarged appendix or an abscess by using sound waves to provide images. Ultrasound is also helpful in rule out the presence of conditions involving the ovaries, fallopian tubes and uterus that can be confused with appendicitis.
This is an X-ray test in which liquid barium is inserted into the colon from the anus to fill the colon. The images on the colon in the area of the appendix can be viewed.
Barium enema also can rule out other intestinal problems that can be confused with appendicitis, such as Crohn's disease.
A CT scan of the area of the appendix can be done to diagnose appendicitis and peri-appendiceal abscesses. This is also helpful in ruling out other diseases inside the abdomen and pelvis that can be confused with appendicitis.
Laparoscopy is a surgical procedure in which a small fiber optic tube with a camera is inserted into the abdomen through a small incision made on the abdominal wall. It allows a direct view of the appendix as well as other abdominal and pelvic organs. The inflamed appendix can be removed with the laparoscope if appendicitis is found.
Sometimes a small portion of the appendix may be left behind when the appendix is removed surgically. This piece of appendix may become inflamed and can develop all of the complications of appendicitis. Therefore there is possibility to develop another episode of appendicitis if you have had your appendix removed.