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What is appendicitis?

Appendicitis is an inflammation of the appendix. The appendix is a small, fingerlike tube located where the large and small intestines join.

How does it occur?

In most cases the inflammation may be caused by an obstruction of the opening of the appendix by a piece of stool, by a parasite, or by an infection.

What are the symptoms?

The symptoms of appendicitis include:

• abdominal pain, usually starting in the middle of the abdomen around the umbilicus (belly button), then shifting to the right lower side of the abdomen
• nausea
• vomiting
• pain when touched on the right side of the abdomen
• fever, usually not very high.

How is it diagnosed?

Sometimes it is difficult to diagnose appendicitis. Your doctor will review your symptoms and examine you. The doctor will probably ask you to give a urine sample.

The doctor may order the following lab tests:

• complete blood count (CBC) to determine your white blood cell count
• chest x-rays (because pneumonia in the lower right lung can also cause abdominal pain)
• x-ray of the abdomen.

How is it treated?

If the doctor hospitalizes you, you may be watched closely for 12 to 24 hours to determine whether surgery is necessary. Alternatively, your doctor may decide to remove your appendix immediately (an appendectomy).

It is important to remove an inflamed appendix before it ruptures. If an inflamed appendix ruptures, infection may move into the abdomen, causing peritonitis (an inflammation of the lining of the abdomen). The rupture might also cause an abscess (infected sore) near the place where the appendix ruptured. If the appendix does rupture, the doctor may leave a drainage tube in the abdomen for a few days after surgery.

After surgery you will be given antibiotics. These may be continued 24 hours or many days, depending on whether your appendix ruptured and caused peritonitis.

For the first day or so after surgery, you will not be given anything to eat or drink. Then your doctor will allow you to have small amounts of water, later clear liquids, and finally some solid food until you are able to handle a regular diet.

Because doctors cannot always be sure that the appendix is inflamed until they examine it during surgery, about 15% of appendixes are removed that are not inflamed. However, it is appropriate for a surgeon to risk removal of a normal appendix so that he or she is sure to not miss a case of true appendicitis.

If your doctor does not hospitalize you and sends you home without surgery, your doctor will probably ask you to:

• Use no pain medication. Taking pain medication could make it difficult for you to know if the pain gets better or worse.
• Use no enema or laxatives because they increase the probability of rupture of the appendix.
• Take no antibiotics.
• Contact the doctor if any changes occur in 6 to 12 hours.
• Bring a urine sample with you when you return in 24 hours for another exam.
• If you are returning for another exam, do not eat or drink anything on the day of your exam.
• Take your temperature every 2 hours and keep a record. Bring it with you when you return to see the doctor.

If your doctor sends you home, call the doctor if any of the following occur:

• continued vomiting
• increased pain in the abdomen
• higher fever
• fainting
• blood in vomit or bowel movement.

How long do the effects last?

The usual stay in the hospital after an appendectomy is less than 4 days if your appendix did not rupture. If your appendix ruptured, you may stay in the hospital 7 days or longer.

How can I take care of myself?

The most important factor in your recovery after surgery is following the full course of treatment ordered by your doctor, including taking all of any prescribed antibiotics. To feel better as soon as possible you should:

• Rest.
• Get plenty of sleep but avoid staying in bed for long periods of time during the day.
• Eat foods high in protein while you are healing if your doctor says it is OK.
• Eat small frequent meals.
• Gradually increase your walking and activity as directed by your doctor.
• Keep your sutures clean.
• Wash your hands before and after changing the dressing on your incision, and after disposing of the dressing.
• Continue taking prescribed medication until it is finished.
• Contact your doctor if the following signs of wound infection appear:
  • redness or warmth at the suture site
  • fever.

Can I help prevent appendicitis?

There is no way to prevent appendicitis. However, appendicitis is less common in people who eat foods containing fiber and roughage such as raw vegetables and fruits.

If you think you might have appendicitis, call your doctor immediately so that if your appendix is infected, it can be removed before it ruptures.