a. Definition. Appendicitis is the inflammation of the vermiform appendix. The
appendix, a narrow, blind tube located at the tip of the cecum, becomes inflamed.
b. Etiology. An obstruction occurs, and the contents of the appendix cannot
empty normally. The obstruction may be a fecalith (a hardened piece of stool),
inflammation, a foreign body, or a tumor. The intestinal contents locked in the appendix
are full of bacteria. Prolonged contact of this bacteria with the tissues of the appendix
often produces infection. Infection of the appendix occurs quickly followed by
inflammation. Perforation occurs if inflammation weakens the appendix tissues.
Perforation is a dangerous complication because if the intestinal contents spill into the
peritoneal cavity, the result can be generalized peritonitis or an abscess.
c. Signs and Symptoms. Appendicitis seems to be more common among
adolescents and young adults, but this disorder can occur at any age. The most
common initial symptom is an attack of severe abdominal pain. Signs and symptoms
progress in this manner:
(1) At first, pain is generalized in the abdominal area. Later, the pain
becomes concentrated in the right, lower quadrant of the abdomen. The most severe
pain is usually midway between the umbilicus and the right iliac crest at a point called
(2) Next, loss of appetite, moderate feeling of being sick, slight fever (up to
102F) and mild nausea.
Vomiting, if it occurs, appears next.
(4) Eventually (from 2 to 12 hours), pain shifts to the right side localizing in
the right lower quadrant.
(5) Pain persists as a steady soreness made worse by walking or coughing.
The patient finds that he is most comfortable lying still and drawing the right leg up to
relieve tension on the abdominal muscles.
Constipation usually, but sometimes diarrhea.
Bowel sounds are diminished or absent.
Ninety-five percent of appendicitis cases have a tendency to become
progressively worse and develop the complication of perforation.