Appendicitis Description:

Appendicitis is an inflammation of the lining of the appendix and if left without treatment, spreads to its other portions. When the appendix becomes inflammed (appendicitis), a sharp pain is felt in the lower right quadrant of the abdomen. By this time the appendix has usually become filled with pus. If not treated right away the infection can spread through the wall of the appendix and can turn into gangrene (necrotizing dead tissue) and rupture. Because of this, it is imperative that it should be dealt with immediately.

Causes:

Demographic Profiles:

Appendicitis occurs the most often in adults 20 - 40 years old. However, it does occur infrequently in infants and older people. Incidents of appendicitis occur have decreased over time (last half of the 20th century). About one in 500 people have appendicitis every year and of these, approximately 80% have an appendectomy (appendix removal)

Specific Causes

The causes of appendicitis are not exactly known but it is surmised by most medical experts to be a result of either:

• Inflammation caused by a bacterial infection. The infection happens when a rigid particle of stool gets blocked at the opening of the appendix passageway where it meets the large intestine. This blockage causes pressure on the blood vessels in the area causing a halt or restricted blood circulation to the appendix. Eventually some of the tissue dies and begins to necrotize (rot) causing inflammation and an overabundnace of white cells to flock to the area. When these white blood cells have finished attempting to neutralize the dead tissue and as a result die themselves, they form pus and a full-fledged infection is in progress. If left alone without intervention, the appendix will usually rupture within 36 hours.
  
• Viral infections. Various viruses attack the biliary and intestines and a secondary result of these infections could lead to an infected appendix (appendicitis).

Symptoms

Sharp pain in the lower abdomen causing one to bend over to alleviate the pain. The pain often  begins near the navel and moves down to the lower right quadrant. The painful area is sensitive to movement or touch.

Classical symptoms of appendicitis that accompany the pain are:

• Nausea
• Vomiting
• Temperature above 101F.
• Elevated pulse 
• Loss of appetite
• Constipation
• Swelling in the lower abdomen

These symptoms tend to become more severe as time passes BUT a word of caution...not everyone with appendicitis has all the symptoms at the same time.

Cautions:   Never take laxative or enema if you have that sharp pain in the lower right quadrant! If it is appendicitis it will make things worse and might cause the appendix to rupture.

Tests

Usually each of the following tests are performed as part of triage (eliminating possible other causes of the pain).

• A physical test. The physician or triage nurse will first of all attempt to palpitate the thorax area at the front and under the rib cage (at the back) to check for and elminate possible liver or bile duct problems, possible constipation, or kidney/kidney stone problems. 
  
  If you let them press hard enough where the pain is, and if the appendix is swollen, they will be able to feel the "knot" of the swollen appendix. If it is is too painful for you, he/she will probably ask you to turn on your left side and they will take your right leg and pull it to note any pain, then bend the knee to the stomach area to see what your reaction is. If the pain is too great,  the diagnosis is probably appendicitis.
• A urine test to rule out a urinary tract infection (UTI).
• An ultrasound which will pick out the swollen appendix.
• A blood test to check increased white blood count levels, a sure sign of infection, which is essentially what appendicitis is...an infection of the appendix.

If severe appendicitis is diagnosed, you will probably be in the operating room within 4 hours. 

Failure to remove the appendix immediately might cause the appendix to burst, spraying highly infectious pus throughout the peritonem. This crisis situation is called peritonitis, and if not immediately cleaned out, will cause death within hours.

Treatment:

Depending on the severity of the appendicitis, a physician will take the following actions:

• In a mild attack, antibiotics to reduce the infection
• In most cases, surgery to remove the inflamed appendix - known as an appendectomy.