When Is a Pain in the Gut Appendicitis?

Appendicitis, an inflammation of the appendix, is an emergency. Left untreated, the inflamed appendix can burst or start leaking, and spread bacteria from the colon into the abdominal cavity. In the days before antibiotics, this was a death sentence. Even today, with antibiotics, three percent of the patients with a ruptured appendix will die from it. Because the initial presentation of appendicitis changes with age, children and the elderly are most likely to have a delay in the diagnosis which translates into a higher rate of rupture and death. Surgical removal of the appendix before it ruptures prevents death 99.9 percent of the time.

Most Americans know that appendicitis is characterized by a severe pain in the abdomen, particularly on the lower right side. Even so, appendicitis is easy to mistake for other ailments. In the early stages, it is frequently dismissed as insignificant.

The appendix is a narrow, worm-like extension of the large intestine, usually about three inches long, that has no known function. Appendicitis occurs when the inside lining of the appendix becomes blocked and then inflamed and swollen. If left untreated, appendicitis can lead to infection, blockage of blood flow, gangrene, and, eventually, rupture of the appendix with life-threatening infection spreading throughout the inner body cavity.

About seven percent of Americans get appendicitis, and there is apparently some family connection. Appendicitis can strike at any age but most frequently occurs between ages 10 and 30.

“Pain is usually the key symptom,” said Jerome Andres, MD, FAAFP, Ministry Medical Group in Woodruff. “Note the precise location and nature of the pain so you can tell your doctor. Typically, appendicitis pain starts in the mid abdomen, near the navel, and then shifts to the lower right quadrant only after the inflammation spreads to structures surrounding the appendix. The pain may get worse when you cough, sneeze, take a deep breath or move around.”

When touched gently, the specific area will feel tender, and this tenderness may get worse right after the pressure is released. This is what is known as rebound pressure, and it is a sign that doctors use when making a diagnosis.

The location and nature of the pain may vary, however, particularly in young children and pregnant women.

As the pain gets worse, it may be accompanied by other symptoms: nausea and sometimes vomiting; loss of appetite; constipation (or in some cases, diarrhea); inability to pass gas; abdominal swelling; and a low-grade fever that may come on relatively late.

“In most cases, a doctor can diagnose appendicitis through listening to a history of symptoms and conducting a physical examination,” said Dr. Andres. “A blood test may indicate the presence or absence of an infection. A urine test will rule out a kidney stone or urinary tract infection as the cause. If necessary, imaging tests such as ultrasound or CT scan may be used to confirm the diagnosis.”

The blockage that leads to appendicitis may be caused by a foreign object, an infection, food waste or a hard piece of stool (fecal stone) that becomes trapped in the appendix. Sometimes tumors or parasites will cause the blockage. In any case, bacteria invade rapidly, and the inflamed appendix becomes filled with pus and mucus.

The most serious consequence is a ruptured appendix, with the contents of the intestine–including the infectious organisms–flooding the abdominal cavity. An infection of the lining of the body cavity (peritonitis) is clearly life threatening, even with emergency treatment.

“When an appendix ruptures, the patient usually feels immediately better, with relief from the severe localized pain,” said Dr. Andres. “Within a short time, however, the entire abdomen will become swollen with gas and fluid. There will be pain, tightness and tenderness throughout the abdomen. Other signs may include fever, thirst and difficulty urinating.”

Children are more vulnerable than adults to rupture, perhaps because it’s more difficult for them to communicate the nature and severity of symptoms. Older adults are more likely to seek treatment when rupture has already occurred or is imminent. This may be because their symptoms are less dramatic and more easily confused with those of other medical conditions.

Another effect of appendicitis may be seepage of intestinal contents into an abscess, a walled-off area of infection that may be as small as a walnut or as large as a grapefruit. This abscess requires prompt treatment; otherwise, it will rupture, leading to peritonitis.

At any stage, appendicitis requires surgery, either by traditional abdominal surgery or laparoscopy, using several small incisions and a fiber optic scope. If an abscess is present or the appendix is ruptured, traditional surgery is required to allow the surgeon to clean the abdominal cavity. Antibiotics can be administered intravenously.

If you suspect appendicitis, it’s important not to take anything by mouth until you’ve talked with your doctor. It’s also important not to take pain medications, as they may mask the pain and make diagnosis more difficult. And don’t take laxatives or have an enema since these may lead to rupture of the appendix or an abscess.

With prompt action, appendicitis can be readily treated with no lasting effects on digestion or other bodily functions.

For more information or to schedule an appointment with a Ministry Medical Group provider call 715-356-8920 in Woodruff or 715-477-3000 in Eagle River.

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