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Appendix: a small, finger-shaped tube that branches off the large intestine.

Anatomical landmarks

 

Appendicitis: Appendicitis is a sudden inflammation of the appendix. Appendicitis is one of the most common causes of emergency abdominal surgery in children. Approximately 4 appendectomies per 1,000 children are done annually in the United States.

Appendicitis is more common in males than in females, and incidence peaks in the late teens and early 20s. The condition is uncommon among children younger than 2, but it can occur.

Appendicitis generally follows obstruction of the appendix by feces (fecalith), a foreign body, or rarely, a tumor. Typically, the first symptom is crampy or "colicky" pain around the navel (periumbilical). There is usually a marked reduction in or total absence of appetite, often associated with nausea, and occasionally, vomiting and low grade fever.

As the inflammation in the appendix increases, the pain tends to move downward and to the right (right lower quadrant) and localizes directly above the position of the appendix at a point called "McBurney's point." If a line is drawn from the navel to the prominence on the right pelvic bone (right superior iliac crest) and divided into thirds, McBurney's point is two-thirds of the line from the navel. Pressing the abdomen at McBurney's point causes tenderness in a patient with appendicitis. When the abdomen is pressed, held momentarily, and then rapidly released, the patient may experience a momentary increase in pain. This "rebound tenderness" suggests inflammation has spread to the peritoneum.

If the appendix ruptures, the pain may disappear for a short period and the patient may feel suddenly better. However, once peritonitis sets in, the pain returns and the patient becomes progressively more ill. At this time the abdomen may become rigid and extremely tender.

Symptoms:

  • Abdominal pain - Pain may begin in the upper-middle abdomen (epigastric), then develop to sharp localized pain Pain may shift from the epigastric area to become most intense in the lower right side of the abdomen ("typical" case), tenderness of this area is common Pain initially may be vague, but becomes increasingly more severe Abdominal pain may be worse when walking or coughing. The patient may prefer to lie still; sudden jarring motions or bumping can cause pain.
  • Point tenderness, especially over the right lower quadrant of the abdomen
  • Nausea and vomiting
  • Fever usually occurs within several hours

Later symptoms can include:

  • Fever
  • Loss of appetite
  • Nausea
  • Vomiting
  • Constipation
  • Rectal tenderness
  • Chills and shaking
Additional symptoms that may be associated with this disease include bloody urine (microscopic hematuria).

Call your health care provider if you develop abdominal pain in the lower right quadrant or any other symptoms suggestive of appendicitis.

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