Classic presentation of acute appendicitis begins with pains, with vomiting setting in and fever coming in lastly. The appendix’s innervation enters the spinal cord at the same level as the umbilicus so the pain begins higher up the stomach area [7]. As the appendix becomes more swollen and irritates the adjoining abdominal wall, it will localise over a few hours into the right lower quadrant. The only exception is with children younger than 3 years of age. The pain is often severe and can be elicited through various signs.

The signs include localised findings in the right iliac fossa and the abdominal wall becomes very sensitive to gentle pressures and palpation.

• Fever

  Additional symptoms may include loss of appetite, nausea, vomiting, and low-grade fever. [innerbody.com]

  Other symptoms that may be present are poor appetite, nausea, vomiting and fever. Initially you may complain of pain in the lower abdomen that is mild to severe in intensity. [sharecare.com]

  The classic symptoms of appendicitis are pain, nausea, vomiting, and low-grade fever in adults. Children tend to have higher fevers. [medical-dictionary.thefreedictionary.com]

  After ruptured appendicitis, the patient is kept in the hospital until the fevers have resolved for 24 hours, and the child is tolerating a regular diet. [surgery4children.com]

  Since appendicitis is an infection in the body, fever and chills may develop. The fever may increase to 100 or 101 degrees F. A person may feel shaky with the fever and chills. [livestrong.com]

• Abdominal Pain

  Symptoms The predominate symptom of appendicitis is abdominal pain originating at the navel (periumbilical pain) then shifting to the right lower abdomen. [innerbody.com]

  The main symptom of appendicitis is abdominal pain. [emedicinehealth.com]

  Evaluation of abdominal pain in children can be difficult. Rapid, accurate diagnosis of appendicitis in children reduces the morbidity of this common cause of pediatric abdominal pain. [ncbi.nlm.nih.gov]

  Rapid, accurate diagnosis of appendicitis in children reduces the morbidity of this common cause of pediatric abdominal pain. [jama.jamanetwork.com]

• Vomiting

  Other symptoms that may be present are poor appetite, nausea, vomiting and fever. Initially you may complain of pain in the lower abdomen that is mild to severe in intensity. [sharecare.com]

  Dull pain near the navel, loss of appetite, nausea, vomiting, abdominal swelling, fever, and inability to pass gas. [earthclinic.com]

  After an appendectomy, call your doctor if you have: Uncontrolled vomiting Increased pain in your abdomen Dizziness /feelings of faintness Blood in your vomit or urine Increased pain and redness in your incision Fever Pus in the wound Can Appendicitis [webmd.com]

  Most common in children and adolescents, the symptoms can include abdominal pain, fever and vomiting. Scientists are still unclear about the exact role the appendix plays in your body. [medibank.com.au]

  The classic symptoms of appendicitis are pain, nausea, vomiting, and low-grade fever in adults. Children tend to have higher fevers. [medical-dictionary.thefreedictionary.com]

• Nausea

  Other symptoms that may be present are poor appetite, nausea, vomiting and fever. Initially you may complain of pain in the lower abdomen that is mild to severe in intensity. [sharecare.com]

  A person suffering from appendicitis may experience symptoms such as nausea and vomiting. The nausea and vomiting usually begin after the pain begins. [livestrong.com]

  […] the usual signs and symptoms of appendicitis include: Early Symptoms Constipation, diarrhea, or gas Dull, achy pain beginning around the belly button (navel), turning to sharp pain in the lower right portion of the abdomen Loss of appetite Low fever Nausea [sepsis.org]

  Accompanying symptoms may include slight fever (above normal but less than 100 degrees), vomiting or nausea. Some individuals, particularly children, experience loss of appetite. [radiologyinfo.org]

• Constipation

  Additionally, painful urination, vomiting prior to abdominal pain, severe cramps, constipation, and diarrhea occur in nearly 50% of cases of the condition. [earthclinic.com]

  While everyone is different, the usual signs and symptoms of appendicitis include: Early Symptoms Constipation, diarrhea, or gas Dull, achy pain beginning around the belly button (navel), turning to sharp pain in the lower right portion of the abdomen [sepsis.org]

  Constipation. Abdominal swelling. Lack of appetite. Note : Not everyone will have all of the symptoms. If you have symptoms of appendicitis, it is important that you do not take laxatives or enemas to relieve constipation. [my.clevelandclinic.org]

• Diarrhea

  RESULTS: factors associated with complications were fever, radiological and sonographic changes, abrupt positive decompression and diarrhea. [ncbi.nlm.nih.gov]

  While everyone is different, the usual signs and symptoms of appendicitis include: Early Symptoms Constipation, diarrhea, or gas Dull, achy pain beginning around the belly button (navel), turning to sharp pain in the lower right portion of the abdomen [sepsis.org]

  Constipation or diarrhea with gas and cramping are also symptoms that can occur. [bouldermedicalcenter.com]

  Other symptoms include: nausea and vomiting loss of appetite fever constipation diarrhea Symptoms of appendicitis begin as referred pain around the belly button when the appendix starts getting irritated. [sharecare.com]

  The most frequently experienced symptoms of this infection in pregnant women include: Nausea and vomiting Appetite loss Pain in the abdomen at the lower right For pregnant women, fever and diarrhea are less common. [newhealthadvisor.com]

• Tachycardia

  You attach him to a cardiac monitor, which shows sinus tachycardia with a rate of 120 beats/minute. Collect specimens for urinalysis and blood work, including a complete blood cell count with differential and electrolytes. Prepare Mr. [journals.lww.com]

  Fever is usually low-grade with mild tachycardia. Less then 50% of children will have a classic presentation of appendicitis, despite having appendicitis. If diagnosis is delayed beyond 48 hours, perforation rate exceeds 65%. [sages.org]

  They may be tachycardia and a pyrexia up to 38 o C present. Very high temperatures suggests a different pathology. The patient is classically tender in the abdomen at McBurney's point. [web.archive.org]

  The presence of pyrexia (up to 38°C) with tachycardia is common. Abdominal examination reveals localised tenderness and muscular rigidity after localisation of the pain to the right iliac fossa. [ncbi.nlm.nih.gov]

  Other indications of peritonitis include increasing abdominal distension, acute abdomen, tachycardia, rapid and shallow breathing, and restlessness. [medical-dictionary.thefreedictionary.com]

• Flank Pain

  There may also be some back or flank pain. If there is stomach pain, this may result from another condition. Other conditions with similar symptoms Abdominal pain can be a symptom of other conditions that seem like appendicitis. [medicalnewstoday.com]

  McBurney sign ) pelvic pain, diarrhea and tenesmus (pelvic appendix) flank pain (retrocaecal appendix) groin pain - appendix within an inguinal hernia ( Amyand hernia ) or a femoral hernia ( De Garengeot hernia) leukocytosis nausea and vomiting atypical [radiopaedia.org]

• Pelvic Pain

  In this multicenter retrospective study, the cases of pregnant women who underwent MRI evaluation of abdominal or pelvic pain and who had clinical suspicion of acute appendicitis between June 1, 2009, and July 31, 2014, were reviewed. [ncbi.nlm.nih.gov]

  For example, a retrocecal appendix can produce right flank or pelvic pain, whereas malrotation of the colon results in transposition of the appendix and, subsequently, pain to the left upper quadrant. [web.archive.org]

  Appendicitis that occurs in these people can cause lower back pain or pelvic pain. Mild fever Appendicitis usually causes a fever between 99°F (37.2°C) and 100.5°F (38°C). You may also have the chills. [healthline.com]

• Lethargy

  In the early stage of appendicitis, infants may primarily demonstrate lethargy, irritability, and loss of appetite. They may not develop vomiting, fever, and pain until late. Pregnant women. [innerbody.com]

  In infants, nonfocal findings such as lethargy, irritability, and anorexia may be present in the early stages, with vomiting, fever, and pain apparent as the disease progresses. [web.archive.org]

Diagnosis is based almost entirely on the presentations and so it is often difficult as there are other conditions that can present same symptoms as appendicitis [8]. When the medical history and presentations isn’t enough to form a definitive diagnosis other approaches that can be considered include:

• Gross and Microscopic Evaluation
• Radionuclide Scanning
• CBC Count
• C-Reactive Protein
• Liver and Pancreatic Function Tests
• Urinary 5-HIAA
• Urinalysis
• Urinary Beta-HCG
• CT Scanning
• Abdominal Radiography
• Ultrasonography
• Barium Enema Study
• MRI

However, care must be taken to ensure that too much time is not spent on the diagnostic procedure.

• Neutrophilia

  Abstract A 31-year-old healthy man presented with right lower quadrant pain and tenderness, mild neutrophilia and clinical presentation consistent with appendicitis, despite undergoing a laparoscopic appendicectomy 5 years prior. [ncbi.nlm.nih.gov]

  Looking particularly for a neutrophilia CRP, but an absence of a rise does not exclude the diagnosis Amylase. Pancreatitis can mimic any abdominal condition eCXR and AXR have not role in the diagnosis of acute appendicitis. [web.archive.org]

  >75-78% of patients Less than 4% of patients with appendicitis have a WBC count less than 10,500 cells/µL and neutrophilia less than 75% In infants and elderly patients, a WBC count is especially unreliable because these patients may not mount a normal [emedicine.medscape.com]

• Leukocytosis

  Blood test results revealed leukocytosis. Computed tomography of the abdomen and pelvis showed evidence of acute appendicitis and a linear hyperdensity (foreign body) perforating the appendix. [ncbi.nlm.nih.gov]

When appendicitis is suspected, the patient is admitted to the hospital. Laparotomy is used to remove the inflamed appendix. The inflamed appendix is found and cut off the caecum while a stitch is used to prevent any contents in the gut from leaking out. Antibiotic medicines are often given just before the operation so as to reduce the risk of an infection developing at the site of operation [9].

The most common reason for emergency abdominal surgery is acute appendicitis. The appendectomy leads to a complication 4-15% of the time. This is not counting the discomfort of hospitalisation and surgery as well as associated costs [6].

Delayed diagnosis and treatment is one of the major causes of morbidity and mortality and therefore the goal of the surgeon is to ensure early and accurate diagnosis.

The overall mortality rate is 0.2-0.8% and this can be attributed to complications of the disease instead of the surgical intervention in itself. In children, the mortality rate ranges from 0.1% to 1% while in patients that are older than 70 years of age, the rates rise above 20% basically due to late diagnosis and delay in therapeutics.

Acute appendicitis is the end result when the appendix lumen is obstructed. When this happens, the appendix becomes filled with mucus and swells [2]. This increases pressures inside the appendix walls and lumen leading to occlusion of the small vessels, stasis of lymphatic flow and thrombosis. At this stage, it is very difficult for spontaneous recovery to occur. With the thrombosis continues to spread, the appendix first becomes ischemic and after a while it becomes necrotic. The dying walls begin to leak bacteria and thus suppuration occurs (pus around and within the appendix). An appendiceal rupture or a burst appendix is the end result of the cascade. When this happens, peritonitis sets in leading to septicaemia and death in many cases.

The main causative agent for peritonitis is faecal deposits referred to as fecaliths or appendicoliths but the following have also been known to cause appendicitis: lymphadenitis, intestinal worms, trauma, foreign bodies and bezoars.

Appendicitis is one of the most common surgical emergencies. It is also one of the most common causes of abdominal pain. In the United States for example, there are 250,000 cases of appendicitis reported every year. Since the 1940s however, the incidence of appendicitis has continued to decline and presently, the annual incidence is 10 cases for every 100,000 people. 7% of the US population get appendicitis meaning 1.1 cases for every 1000 people each year. There have been talks of familial predisposition as well [3].

In Africa and Asia, the incidence of acute appendicitis is lower and this may be due to dietary habit of the individuals in those geographic areas. Records show that appendicitis is lower in cultures where there is a higher intake of dietary fibre. Dietary fibre is believed to decrease the viscosity of faeces and this decreases time for bowel transit thereby discouraging the formation of fecaliths which will predispose individuals to obstructions of the appendiceal lumen.

Over the last few years, there has been a marked decrease in the frequency of appendicitis in Western Countries. This may be related to changes in the intake of dietary fibre. This has given credence to the theory that a higher incidence of appendicitis in those areas is as a result of poor intake of fibre in such countries.

In teenagers and young adults, there is a slight male preponderance of 3:2. In adults, the incidence in men is 1.4 times greater than in women. There is equality in primary appendectomy in both males and females [4].

The obstruction of the appendiceal lumen is what causes appendicitis as seen above in the etiology. The obstruction brings about an increase in pressure within the lumen and this increase in pressure is related to the continual secretion of fluids and mucus from the mucosa as well as stagnation of the secreted material [5].

At the same time intestinal bacteria within the appendix multiplies leading to the recruitment of the white blood cells. This leads to the formation of pus while intraluminal pressure continues to increase.

When appendiceal obstruction persists, the intraluminar pressure will go beyond the pressure of the appendiceal veins leading to the outflow of the obstruction. Consequently, appendiceal wall ischemia will begin leading to a loss of epithelial integrity which will allow appendiceal wall to be invaded by bacteria.

In a few hours, the localised condition will worsen due to thrombosis of the appendicular artery and veins. This will lead to perforation and gangrene of the appendix. As the process continues, peritonitis or a periappendicular abscess may occur.

There is no way to predict when appendicitis will occur and thus prevent it from happening but epidemiological evidence suggest the need to avoid diets that are low in fibre and high in sugar.

Also, infections and a family history increase chances of developing appendicitis [10].

Also referred to as epityphlitis, appendicitis is the inflammation of the appendix. It is a surgical emergency in many cases [1]. Due to the high level of mortality associated with a ruptured appendix and the fact that it can bring about sepsis and peritonitis, most cases of appendicitis require a removal of the inflamed appendix by laparoscopy and laparotomy.

It was first described in 1886 by Reginald Fitz and today, it is recognised as one of the most significant causes of severe and acute abdominal pain in the world today.

Appendicitis is a disease where your appendix gets filled with pus and inflamed. The appendix is a projection from the colon  and it is found in the lower right part of the abdomen. Although the appendix doesn't have any known benefits to the body, it can still cause a great deal of problems. 

When appendicitis sets in, the symptoms often beging around the belly button before shifting to the lower right abdomen. The pain of appendicitis increases within 18 hours of first signs, becoming severe. 

This condition can affect anyone but it is mostly seen in people aged 10-30. 

The main treatment is the surgical removal of the appendix. 

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