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Appendicitis: Symptoms, Treatment and Diagnosis

Illustration of a woman holding her side in pain

Introduction and Summary

It is estimated that one in 20 people in the U.S. will get appendicitis at some point in their lifetime. To understand this condition, let’s first take a closer look at the appendix. This organ is a part of our large intestine and is located in the lower right part of our abdomen. More specifically, the appendix is a small, finger-shaped tube that sticks out from the cecum, the part where our large and small intestines meet. Once thought to play an important role in shaping our body’s immune system, the appendix is now widely considered to be a vestigial organ. This means it no longer serves much of a purpose. Simply put, we can live without the appendix. This is why surgically removing it is the best treatment for appendicitis.

Topics in this article include:

What Is Appendicitis?

Appendicitis is when the appendix gets inflamed and infected. Inflammation can happen when the opening of the appendix gets blocked. Such blockages are often hard for doctors to detect, even in surgery. This makes it impossible to know with 100% certainty what causes appendicitis. That being said, the following are what doctors widely recognize as being the main causes of blockages to the appendix:

  • A piece of stool, which sometimes forms a small stone
  • Swelling of lymph tissues within the appendix wall. This swelling can be a response to an infection in the appendix or elsewhere in the body.
  • Organisms, like worms
  • Tumors

Once a blockage of the appendix occurs, several things happen. First, the appendix cannot empty the fluid and mucus that it produces. This causes pressure to build within the appendix. As the pressure rises, blood flow to the appendix gets impaired, and the cells inside it start to die. Meanwhile, bacteria in the appendix rapidly multiply, causing the organ to swell even more and occasionally fill with pus.

If the infection is not treated, and the pressure inside the appendix rises past a critical point, the appendix can rupture, or burst. As a ruptured appendix can be life-threatening, especially if not promptly treated, appendicitis is considered a medical emergency. The most recommended course of treatment is to surgically remove the appendix.

What Are Appendicitis Symptoms?

Someone with appendicitis will feel pain in the lower right abdomen. In many cases, though, appendicitis pain may actually begin around the belly button before shifting downward and to the right. As the inflammation gets worse, the pain increases, and can eventually become quite severe.

Here are common symptoms for appendicitis:

  • Dull pain around the belly button that grows increasingly sharp as it moves to the lower right abdomen
  • Severe pain in lower right abdomen when physically pressed
  • Abdominal swelling
  • Reduction in urination (in severe cases)
  • Low-grade fever (which can rise to over 101° F if inflammation becomes severe and appendix bursts)
  • Nausea and/or vomiting
  • Loss of appetite
  • Diarrhea
  • Inability to pass gas

Anyone can develop appendicitis. However, it most often occurs in 10- to 30-year-olds. For pregnant women, there may be additional symptoms that appear. These can include:

  • Heartburn
  • Gas
  • Diarrhea
  • Pain in behind

It is important to seek medical attention promptly after experiencing any of these symptoms. This is because the risk of a ruptured appendix can increase anywhere between 48-72 hours after these symptoms first appear. While it is unusual for any life-threatening developments to happen within the first 24 hours of the onset of symptoms, appendix pain, inflammation and infection can progress the longer you wait to treat them.

How Is Appendicitis Diagnosed?

At the onset of symptoms, it’s a good idea to see a doctor right away for a professional evaluation. During your visit, your doctor will most likely perform a physical exam and ask for details about your symptoms. He or she will also order blood tests to check for signs of infection. To look for signs of an inflamed appendix, other images will most likely be taken, including an abdominal ultrasound, a CT scan, or an MRI. Your doctor will make a clinical diagnosis based on your overall picture.

What Complications Are Associated with Appendicitis?

The following are serious complications that are associated with appendicitis.

Ruptured appendix

Left untreated, an inflamed appendix will eventually rupture. When this happens, infectious materials from the bowel that have built up within the appendix spill over into the abdomen. This can lead to inflammation of the lining of the abdomen that can be fatal unless immediately treated. Treatment of a ruptured appendix includes surgery to remove the appendix and wash out the abdomen, as well as strong antibiotics.

The following are symptoms of a ruptured appendix:

  • Low blood pressure
  • Severe abdominal pain
  • High fever
  • Lightheadedness
  • Sweating
  • Feeling really ill

Ideally, you should seek medical attention before your appendix ruptures. However, if your appendix has already ruptured, immediate surgery (within 24 hours of a rupture) is a must.

Abdominal abscess

If your appendix bursts, a small area of infection called an abscess may form in your abdomen. This abscess contains the infectious materials from your bowel mentioned in the previous point. If this happens, a surgeon will need to drain the abscess. This is done by inserting a tube through your abdominal wall and into the abscess. This tube will remain in place for about two weeks, while you’re given antibiotics to clear the infection. Once the infection is clear and the abscess is drained, you will then have surgery to remove your appendix.

What Conditions Are Related to Appendicitis?

So far, this article has focused on acute appendicitis, a condition whose timeline from symptoms to treatment takes no more than one week. There is a related condition, called chronic appendicitis, which is worth noting. Patients with chronic appendicitis experience a less aggressive degree of inflammation and pain in the right lower abdomen for more than a week. People often confuse chronic appendicitis with acute appendicitis because the symptoms are very similar. The major difference between the two conditions is that with chronic appendicitis, the symptoms are milder and last longer.

Symptoms of chronic appendicitis include:

  • Dull abdominal pain, around the naval and/or in the lower right abdomen
  • Low-grade fever
  • Abdominal swelling and tenderness
  • Lack of energy
  • General discomfort
  • Nausea
  • Diarrhea

Another difference is that the symptoms for chronic appendicitis may come and go, which can make the condition more difficult to diagnose. Sometimes, chronic appendicitis isn’t diagnosed until it has already turned into acute appendicitis. So if you have any of the mentioned symptoms, it may be wise to see a doctor, especially if they continue to get more severe.

Appendicitis Treatment Options

Currently, surgery to remove the appendix, called an appendectomy, is the only recommended treatment for appendicitis. In fact, appendectomy is the most common cause of general surgery in the world. According to the American Pediatric Surgical Association, seven percent of people in the United States have their appendix removed during their lifetime. While antibiotics can be prescribed to help clear up any infection in the appendix, surgery is still the preferred choice of treatment. Even in cases where surgeons discover during surgery that the patient’s appendix is actually normal, the appendix is still removed. This is to prevent any future recurrences of appendix pain or appendicitis.

When to See a Doctor About Appendicitis

If you start to have pain and/or inflammation in your lower right abdomen, especially accompanied by a fever, nausea or vomiting, it is strongly recommended to see your doctor. Time is of the essence when it comes to appendicitis. As I mentioned earlier, while a ruptured appendix rarely happens within the first 24 hours of symptoms appearing, the risk of a rupture rises dramatically 48 hours after the onset of symptoms. To prevent getting into a life-threatening situation of a ruptured appendix, it’s worth seeking medical attention as soon as possible after appendicitis symptoms present themselves.

Prevention—What You Can Do at Home

There is no prevention for appendicitis. The best thing to do is to be aware of the symptoms for both acute and chronic appendicitis. That way, you can seek medical attention in a timely manner, before your infection becomes severe or your appendix ruptures, which can be fatal.

In most cases, a clinical diagnosis of appendicitis will result in the surgical removal of your appendix. While appendicitis pain can be severe, the condition is also quite common and treatable. The most important thing to remember when suffering from appendicitis symptoms is to seek treatment as close to their onset as possible to prevent a medical emergency.

How K Health Can Help

Appendicitis is very serious and should be diagnosed as soon as possible. K Health’s virtual diagnosis tool can help you very quickly determine whether your symptoms point to appendicitis and, if so, when you need to seek additional medical attention. Did you know you can get affordable primary care with the K Health app? Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.

Dr. Edo Paz, MD

Edo Paz is the VP of Medical at K Health. Dr. Paz has two degrees in chemistry from Harvard and an MD from Columbia University. He did his medical training in internal medicine and cardiology at New York-Presbyterian. In addition to his work at K Health, Dr. Paz is a cardiologist at Heartbeat Health, a cardiology practice located in New York City.