What Is Appendicitis?

What is appendicitis? To put it simply, appendicitis is when there is inflammation in one of the organs in your digestive tract. The organ in question is the appendix. Obstruction or infection can lead to an inflamed appendix. A common symptom of an inflamed appendix is pain. Appendicitis pain can often be present as a sudden stomach pain, or pain around the belly button. This is referred to in the medical world as ‘acute abdominal pain’. 

So what can cause appendicitis? What are some examples of appendicitis symptoms? What should we do if we have suspected appendicitis? When should we seek medical attention or go to the emergency department? When do we know if we need emergency medicine? Read on to find out!

Overview

When discussing medical terms, any word that ends in ‘-itis’ refers to an inflammation somewhere. It follows, therefore, that appendicitis refers to an inflamed appendix. The appendix is an organ that is a part of your digestive tract. The whole of your digestive tract sits inside the body within the abdominal cavity. The appendix is found near the junction between the small and large intestines, within the abdominal cavity. This junction is usually situated in the lower right abdomen. The appendix itself is attached to the large intestine in most people. 

There are broadly two types of appendicitis: acute appendicitis and chronic appendicitis. Acute appendicitis is when the symptoms come on suddenly, and it is the most commen type. This is usually characterisied by severe abdominal pain that requires pain medicine. It requires urgent medical attention and treatment. If not treated quickly enough, the infection and inflammatory processes can cause an appendix rupture. 

Chronic appendicitis is rare. It tends to present with recuurent, milder symptoms.¹ In some cases, the only symptom is abdominal pain. Chronic appendicitis can sometimes lead to a presentation with acute appendicitis. It is important to get help from health professionals if you have any ongoing abdominal pain. Even if it isn’t chronic appendicitis, ongoing abdominal pain with no clear cause should be investigated. 

Causes of appendicitis

The exact cause of appendicitis is not fully known. However, it is thought that appendicitis is caused by an obstruction at the opening of the appendix. This can either be from a blockage formed by hard poo (faecolith) or from problems with the cells around that area.

There are various risk factors for appendicitis, including:

• Chronic constipation
• Age - appendicitis is more common in young adults (people in their 20s), children, and teenagers (paediatric appendicitis)
• More common in people assigned male at birth (AMAB)
• Intestinal worms²
• Injury to the abdomen
• Tumours
• Enlargement of lymphoid follicles (Lymphoid hyperplasia)³
  • A lymphoid follicle is a collection of cells from the immune system, usually found in lymph nodes

Signs and symptoms of appendicitis

Appendicitis pain tends to start in the belly button region of the abdomen. It can then localise to the lower right part of your abdomen as the condition progresses. The pain tends to begin suddenly and feels worse when you apply any pressure to your abdomen (e.g. through coughing or sitting up). This type of abdominal pain is usually characteristic of appendicitis. Other symptoms of appendicitis include:

• Nausea and vomiting
• Fever
• Changes to bowel movements:
  • Constipation
  • Diarrhoea
  • Struggling to pass gas or passing a lot of gas
• Indigestion
• Loss of appetite
• Abdominal swelling

Management and treatment for appendicitis

Appendicitis requires prompt treatment to prevent the worsening of the condition. This is usually achieved by surgical removal (appendicectomy). If there are complications following appendicitis, this is referred to as ‘complicated appendicitis’. Possible complications of appendicitis include:

• Ruptured appendix (burst appendix)
  • This can lead to bacteria in the abdominal cavity, causing widespread infection affecting the lining of the abdomen (peritonitis)
• Abscess formation
• Sepsis (blood poisoning due to infection)

To prevent the above, acute appendicitis should be treated urgently. Examples of treatment options include:

• Appendicectomy (appendectomy) - this is a form of surgery done to remove the appendix from the abdominal cavity
  • Keyhole surgery (laparoscopic surgery)
    • Laparoscopic surgery is the preferred method
    • Involves 3 or 4 small cuts to access the inflamed appendix and remove it
    • Each cut is a small incision, meaning there are smaller scars
  • Open surgery
    • Open surgery is done if there is complicated appendicitis (e.g. appendix burst or widespread infection)
    • Open surgery can also be done if you have had previous surgery on their abdomen 
• Antibiotic therapy
  • Antibiotics could be considered for selected patients with uncomplicated acute appendicitis, to reduce the risk of complications
  • Antibiotics will also be used if there is progression to complicated appendicitis (e.g. if there is peritonitis, sepsis or an abscess formed), in addition to surgery

FAQs

How is appendicitis diagnosed

Some conditions can have similar symptoms to appendicitis (e.g. urinary tract infection or inflammatory bowel disease). If you have suspected appendicitis there are a variety of tests that the health professionals seeing you may request, including:

• Urine dipstick test
  • This is to rule out a urinary tract infection
  • Can also be used to rule out pregnancy in those with child-bearing potential
• Blood tests
  • To check for inflammatory markers in the blood
• Ultrasound scan 
  • To visualise the appendix
• CT scan
  • To evaluate the abdominal cavity for complicated appendicitis

How can I prevent appendicitis

There’s no specific cause of appendicitis, which means there’s no specific way to prevent appendicitis. Having said that, there are certain lifestyle factors that can minimise the risk factors of appendicitis, including:

• Eating a balanced diet that is rich in fibre
• Regular exercise
• Maintaining good posture
• Worm treatment (according to your doctor’s advice)

Who are at risks of appendicitis

• Appendicitis tends to present in people who are aged 10-30 years old
• Being AMAB
• Family history of appendicitis⁴
• Children who are breastfed for less than 6 months⁵

How common is appendicitis

Appendicitis is a fairly common condition. Roughly 40,000 people are admitted to hospital every year in England due to appendicitis. In terms of lifetime risk, around one in every 13 people will have appendicitis at some stage in their life.

When should I see a doctor

If you have pain that is concerning to you (e.g. severe pain around your belly button or in the lower right abdomen) then you should consult your healthcare provider. Abdominal pain is the main symptom of acute appendicitis, however, there can be other causes for this too. As such it is important to go to see the doctor if you have a new onset of abdominal pain. Examples of other conditions that can cause abdominal pain similar to that of appendicitis include:

• Urinary tract infection
• Inflammatory bowel disease
• Irritable bowel disease
• Mesenteric adenitis
• Diverticular disease

Other worrying symptoms (aka ‘red flag symptoms’) include, but are not limited to:

• Inability to pass gas
• Severe constipation 
• High fever 
• Vomiting 

Summary

Appendicitis is when an obstruction or infection in your appendix causes inflammation. The appendix is an organ that doesn’t serve any major function in our body. Therefore, if you have appendicitis then the doctors will usually recommend surgery. Surgery can be either laparoscopic (keyhole) surgery or open surgery. Surgical removal of the appendix is recommended to minimise the risk of complicated appendicitis (e.g. burst appendix, sepsis, abscess formation, etc.). Once removed, you will likely be given a course of antibiotics to help recovery.

Acute appendicitis is a medical emergency. If for any reason you think you have appendicitis, please seek urgent medical help at an emergency department.