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What is the Appendix? 

The appendix is a 2 to 4-inch long tube-shaped extension of the large intestine (colon) located in the right lower part of the abdomen. In young children, this digestive tract organ is a part of the immune system and helps the body fight infection. In adults, the appendix was thought to serve no purpose, although more recent research suggests it plays a role in maintaining a healthy gut microbiome. 

Is Appendicitis a Medical Emergency?

Yes. Appendicitis is a medical emergency requiring urgent medical care. Appendicitis is an inflammation of the appendix. It commonly occurs in children and young adults and nearly always starts with a blockage in this part of the digestive system. The blockage causes an overgrowth of bacteria or other germs in the appendix. This causes the appendix to become swollen and sore, leading to decreased blood flow. Without enough blood supply, the appendix tissues start to die. If left untreated, an inflamed appendix can rupture (burst). This can happen within 48 to 72 hours of developing symptoms. 

When the appendix bursts, it can lead to serious complications such as abscess formation, peritonitis (an infection of the abdominal cavity lining), and sepsis (a bloodstream infection). 

Because of these possible complications, appendicitis is a medical emergency that requires immediate medical attention. 

There is no way to prevent appendicitis, but if appendicitis occurs, it’s important to recognize the symptoms and seek prompt treatment in the emergency room. This can avoid a potentially life-threatening serious infection from a burst appendix.

What Is The First Stage of Appendicitis?

The first stage of appendicitis is sudden pain that develops in the right lower belly or pain that develops around the belly button and shifts to the lower right belly. 

What Does Appendix Pain Feel Like?

As noted, appendicitis pain typically starts in the middle of the abdomen near the belly button and tends to come and go. Within a few hours, the pain becomes severe and constant and moves to the lower right side, where the appendix is situated. The pain can also start in the right lower abdomen. 

Taking deep breaths, coughing, sneezing, touching or pressing on the area, jarring movements, and walking can all make the pain worse.

If the appendix bursts, the pain may be felt all over the belly with the presence of other symptoms such as nausea, vomiting, and a distended belly.

Other Common Symptoms of Acute Appendicitis

Other symptoms of appendicitis include a swollen belly (abdominal distension), abdominal tenderness, feeling unwell, nausea (feeling sick), vomiting, loss of appetite, trouble passing gas, constipation (difficulty having bowel movements), diarrhea, fever, chills, facial flushing, and urinary frequency or urgency.

Most cases are acute appendicitis requiring emergency medical attention. Rarely do some people develop chronic appendicitis (a mild inflammation of the appendix that comes and goes and lasts for a long time). Chronic appendicitis is much rarer than acute appendicitis.

Classic Symptoms to Identify Appendicitis

The following symptoms are present in people with a classic presentation of appendicitis:

• Sudden pain that starts near the belly button and shifts to the lower right part of the belly

• Abdominal pain that gets progressively worse

• Nausea and vomiting as the pain intensifies.

• Loss of appetite

• Fever and chills as the immune system kicks in to control the infection

Appendicitis Symptoms in Different Populations

Symptoms in Children

Appendicitis is the most common reason for emergency abdominal surgery in children. It can happen at any age but is most common in school-aged children. Appendicitis rarely occurs in children less than a year old. 

Symptoms of appendicitis in children include pain in the lower right part of the child’s abdomen, nausea, vomiting, loss of appetite, mild fever, and diarrhea.

Symptoms in Pregnant Women

It can be challenging to diagnose appendicitis in pregnant women, especially close to the delivery date. This is because appendicitis can present with slightly different symptoms during pregnancy. 

Abdominal pain, nausea, vomiting, and constipation (difficulty having a bowel movement) are common symptoms. In early pregnancy, the abdominal pain occurs in the right lower quadrant. However, in late pregnancy, the appendix is displaced upwards by the enlarging uterus. Therefore, the pain may be present in the right upper part or the entire right side of the abdomen. 

Symptoms in Elderly Individuals

The risk of acute appendicitis is highest in people between the ages of 10 and 30, but it can occur at any age, including in elderly individuals. 

Symptoms of appendicitis in older adults include lower abdominal pain, shifting abdominal pain, loss of appetite, nausea, vomiting, and fever. Elderly people may not have the typical symptoms and signs of acute appendicitis, but rather may present with signs of peritonitis, such as abdominal distention, severe tenderness, and guarding (involuntary tensing of the abdominal muscles).

How Is Appendicitis Diagnosed?

A healthcare provider can make a diagnosis of appendicitis based on symptoms, medical history, physical examination, and test results.

Diagnostic Tests and Procedures

Doctors may order the following tests if they suspect appendicitis: 

• Blood tests to check for signs of infection, such as increased white blood cells

• Urine tests to check for a urinary tract infection

• Imaging studies such as abdominal ultrasound, CT scan, and MRI scan to view the internal organs

MRI scans do not involve radiation exposure and are preferred over CT scans in pregnant women with suspected appendicitis.

How Do You Rule Out Appendicitis at Home?

Do not rule out appendicitis at home without consulting a healthcare provider. Untreated appendicitis can have serious, life-threatening consequences. Any persistent or worsening stomach pain should be evaluated by a healthcare professional. 

However, you can check for appendicitis at home with the following tests:

• Jump Test: Jump to see if it makes the stomach pain worse. Pain that is worse with jarring movements, such as jumping, may indicate appendicitis.

• Hamburger Sign: Abdominal pain without loss of appetite is unlikely to be appendicitis.

• Dunphy’s Sign: Right lower abdominal pain that worsens with coughing may be appendicitis.

• Rovsing’s Sign: If you lay flat on your back and press on the left lower part of your abdomen, worsening pain in the right lower abdomen can be a sign of inflammation in the abdominal cavity.

• Psoas Sign: This test checks for irritation of the iliopsoas muscle that lies in close proximity to the appendix. Lie flat on your back and have someone place their hand just above your right knee. Raise your leg against the resistance offered by the other person. Pain with this maneuver may be a sign of appendicitis.

• Blumberg’s Sign: Sharp pain (rebound tenderness) when you release your hand after pressing down on the right lower abdomen may indicate appendicitis. 

• Leg Extension: Pain while laying on your left side and extending your right hip may be a sign of appendicitis.

Note: These maneuvers can provide clues that the cause of your abdominal pain might be appendicitis, but they should not be used to diagnose appendicitis at home or rule it out. Remember, appendicitis is a medical emergency. Your doctor can make a proper diagnosis based on your symptoms, physical exam, laboratory tests, and imaging test results and provide appropriate medical care. 

When to Seek Medical Attention

You should call your healthcare provider or seek medical attention immediately if you have continuous pain in your lower right abdomen for more than 4-6 hours.

What Can Appendicitis Be Mistaken For?

One of the conditions that can mimic appendicitis is an acute presentation of Crohn’s disease, a type of inflammatory bowel disease. 

Other conditions that can cause symptoms similar to appendicitis include: 

• Mesenteric adenitis (inflammation of lymph nodes in the abdomen)

• Menstrual cramps

• Cecal diverticulitis (inflammation of small pouches called diverticula in the colon or large intestine)

• Salpingitis (inflammation of the fallopian tubes)

• Ruptured ovarian cyst (a cyst in the ovary that bursts open)

• Ectopic pregnancy (implantation of a fertilized egg outside the uterus)

• Musculoskeletal disorders (such as a pulled stomach muscle on the lower right side)

• Gastroenteritis or right-sided colitis

• Irritable bowel syndrome

• Kidney stone pain 

• Conditions of the female reproductive tract, such as tubo-ovarian abscess, endometriosis, and pelvic inflammatory disease

• Ovarian torsion on the right-hand side (twisting of the ovary on the ligaments that support it)

• Round ligament syndrome (pain in the abdomen, hips, and groin that occurs during pregnancy)

• Testicular torsion (rotation of a testicle on the spermatic cord)

• Epididymitis (inflammation of the epididymis, a coiled tube behind the testicle)

Differentiating Appendicitis From Other Abdominal Issues

Healthcare providers can differentiate appendicitis from other abdominal issues and health conditions based on different symptoms, medical history, physical exam, and imaging tests. For example, in a person with a past history of Crohn’s disease, acute abdominal pain will raise a suspicion for ileal inflammation. A CT scan may be done to rule out appendicitis and avoid unnecessary surgery.

How Is Appendicitis Treated?

Appendicitis requires emergency treatment. Antibiotics are given to treat the infection and kill the bacteria causing appendicitis. Antibiotic therapy is also given as preventative treatment before surgery.

Mild appendicitis may improve with antibiotics alone. Doctors may take this approach in people with a high surgical risk. However, appendicitis can return if you don’t have the appendix removed. 

Treatment also consists of medications to relieve discomfort once a diagnosis has been made. You should not, however, take pain medications at home to treat persistent stomach pain because it can mask the signs of a ruptured appendix.

The standard treatment for appendicitis is immediate surgery. The procedure is called an appendectomy or appendicectomy (surgical removal of the appendix). Time is critical as the appendix can rupture within 48-72 hours of the first symptoms of appendicitis. 

Appendectomy surgery can be done with a minimally invasive approach (laparoscopic surgery), in which case you might be able to go home the same day. If you have open surgery or complications from surgery, you might need to stay in the hospital longer. Full recovery from appendectomy takes a few weeks (most people are fully recovered in 6 weeks).