The appendix is an organ averaging 10 cm in length and about 8 mm in diameter that is attached to the large intestine in the lower right quadrant of the abdomen. This tube-like appendage is a vestigial organ which has lost its original function through the evolution of the human species. Scientists believe it once was used to help human ancestors to better digest plants but has evolved into the shrunken and shapeless remnant. Perhaps it was once similar to the long and fully developed cecum found in other herbivores.
What Does the Appendix Do?
Though it is a vestigial organ, its original function long since lost, scientists believe that the appendix has picked up secondary functions. The appendix may protect beneficial bacteria to aid in recovery from intestinal illnesses such as diarrhea. The walls of the organ contain lymphatic tissues and may help to create antibodies. Despite these possible functions, the appendix seems to lack much importance and can be removed in an appendectomy without side effects to the patient.
What is Appendicitis?
Appendicitis is the inflammation of the appendix. If left untreated, the appendix could burst causing an inflammation of the lining of the abdomen, called the peritoneum. Peritonitis can cause shock, and if the patient is still untreated, could cause death. Because of the serious risk of infection, appendicitis is considered a medical emergency and often culminates in the removal of the inflamed organ.
Abdominal pain is usually the first symptom of an inflamed appendix. It typically begins in the center of the abdomen as a dull ache. In the early stages the pain is not localized and difficult to pinpoint the source of the stomach ache. It often occurs suddenly and before any other symptoms.
As the inflammation advances the pain will move from the center of the abdomen near the belly button and become more prominent in the lower right quadrant. The pain will get more intense when moving or even just breathing deeply.
If the peritoneum becomes inflamed it could cause rebound tenderness which is pain when pressure is removed rather than when pressure is applied. For example, applying pressure to the abdomen with a hand then removing the hand the person will feel the pain once the pressure has been released.
Occasionally the appendix can become so inflamed that it ruptures and infection can spread throughout the entire abdomen. When this happens, since the entire abdominal lining is inflamed, the pain is again difficult to locate.
Along with abdominal pain, someone suffering from appendicitis may experience several other symptoms including:
- Decrease in appetite
- Nausea or vomiting
- Constipation or diarrhea
- Low-grade fever
- Swelling in the abdomen
- Feeling of needing to go to the bathroom, but discomfort remains
During a physical exam, a physician collects information about symptoms and medical history. The doctor will ask how long the patient has been experiencing the pain, where the location of the pain is and the level of pain the patient is currently experiencing. To rule out other medical conditions, the doctor will also be interested in any current medical conditions the patient may have as well as any medications that have been taken and for how long.
In the case of very young children and mentally impaired patients who may not be able to accurately describe what they are experiencing, or if a patient is not exhibiting definitive symptoms of appendicitis, further testing may be necessary before a diagnosis.
A physical exam is usually performed to assess the location and severity of pain the patient is experiencing. Doctors will note physical responses that may indicate appendicitis.
Guarding – when a patient’s abdominal muscles become tense as if in anticipation of pain. This can be voluntary or involuntary.
Rebound Tenderness – pain is felt when pressure is released.
Rovsing’s sign – when applying slight pressure to the lower left quadrant of the abdomen pain is felt in the lower right quadrant. This happens because unlike pain receptors in the muscles, pain receptors in the intestines, and the appendix is part of the intestine, are less able to localize pain in an exact spot. Applying pressure to the abdomen stretches the peritoneal lining and may cause pain wherever muscle is becoming irritated by an inflamed peritoneum. When pressure is applied to the lower left part of the abdomen and pain is felt in the lower right it is an indicator of an inflamed organ or tissue in that region, often indicating appendicitis.
Psoas sign – Having the patient lie down, the physician may apply resistance to a patient’s right knee while having them attempt to lift the right thigh which would cause them to flex the psoas muscle that is located near the appendix. If there is pain while flexing this muscle it is an indicator of an inflamed appendix.
Obturator sign – The obruator muscle on the right side of the body is also near the appendix. Flexing this muscle by lying down with the right leg bent and moving it left to right will cause pain in the abdomen if the patient has an inflamed appendix.
Rectal exam – the rectum is often experiences tenderness with an inflamed appendix.
Lab tests – testing the blood for infection, dehydration and electrolyte imbalances as well as a urinalysis to rule out urinary and bladder infections.
Imaging tests – A CT (computerized tomography) scan or ultrasound tests are helpful tools when looking for signs of possible appendicitis.
Due to the very real risk of appendix rupture and spreading infection, appendicitis is generally treated by the removal of the appendix. In most cases, when a patient is exhibiting classic signs of appendicitis surgery is performed without additional testing. The goal being to get the inflamed organ out of the body before it busts and causes additional harm.
An appendectomy can be done through a single incision in the lower right quadrant of the abdomen. This is an older method and most surgeons prefer laparoscopic surgery because there is usually less risk of complication and results in a much quicker recovery. The laparoscopic surgery requires several incisions, though they are very small, and the surgeon uses specialty tools to take out the appendix.
If the appendix has already ruptured an appendiceal abscess may form. This is the body’s way of trying to prevent the spread of infection. If the abscess is found before surgery it likely would be drained of the puss prior to the removal of the appendix. Typically a patient will begin a regimen of antibiotics for about two weeks to treat the infection before the surgery to remove the remains of the ruptured organ.
Occasionally a person is not healthy enough to endure an appendectomy, and in those rare cases appendicitis may be treated with antibiotics and a liquid diet low in fiber. Surgery is still the preferred treatment to prevent further complications or additional infection.
Whether treated with a nonsurgical method or having an appendectomy, most people are able to recover from appendicitis without complication. Patients may be able to resume their normal lifestyle once they have healed from surgery and no further signs of infection or inflammation are present.