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Appendix Pain - Location, Symptoms, Treatment and Surgery

Updated on July 4, 2015
Anatomic Position of Appendix
Anatomic Position of Appendix

Appendix pain usually presents a medical condition which can be very serious. This can be an indicative sign of appendicitis, a medical emergency [1].

Appendicitis is referred to as the inflammation, swelling, and infection of the appendix. This can result to severe abdominal pain and other kinds of symptoms [2]. However, this kind of pain may be mistaken for other conditions, which is less-severe such as ordinary stomach flu [3]. Therefore, knowing how to distinguish this symptom apart from a regular abdominal pain is essential for immediate management [1].

Causes of appendicitis
Causes of appendicitis

Appendix Pain Causes

Actually, experts do not know yet the clear cause of appendicitis. However, mostly, it is believed that appendicitis can happen as a result of the following:

Obstruction

1. Mucus accumulation

  • Thick mucus accumulation within the appendix
  • This leads to increased pressure within walls and lumen of the appendix.
  • As a result, it causes occlusion and thrombosis of the appendix.

2. Fecal deposits

  • Also known as fecaliths or appendicoliths
  • Seen in complicated cases of appendicitis
  • Causes decreased bowel movements in patients with this condition

3. Other conditions causing obstruction include:

  • Crohn’s disease
  • Ulcerative Colitis
  • Foreign body

Infection

1. Lymphatic tissue swelling

  • In lymphadenitis, blockage of the appendix opening also occurs.
  • Following blockage, the bacteria normally located at the appendix begins to infect the walls of the appendix.
  • As the body’s reaction to this, the body will attack the bacteria through inflammation.

2. Other cause of infection within the appendix:

  • Trauma
  • Intestinal worms [1, 4, 5, 6]

Appendix Pain Symptoms

Early Symptoms

  • Abdominal pain: Initially characterized as a dull pain starting from the umbilicus area. Then, it progresses to a sharp pain felt at the right lower quadrant of the abdomen.
  • Abdominal tenderness: This is felt after the pressure applied on the right lower abdominal quadrant is released. This is also referred to as rebound tenderness. It is actually a good indicator that a patient has appendicitis.
  • Loss of appetite
  • Nausea and vomiting
  • Diarrhea, constipation
  • Inability to pass of gas
  • Low fever (temperature of 37°C to 39°C)

Late Symptoms

  • Abdominal rigidity
  • Abdominal swelling
  • Diffused pain

Other symptoms

  • Sharp or dull pain located at the lower or upper abdomen, rectum, back
  • Svere cramps
  • Painful urination [5, 7, 8]

Progression of Appendix Pain
Progression of Appendix Pain
 McBurney’s Point
McBurney’s Point

Appendix Pain Location

At the beginning of appendicitis, it starts at the higher portion of the stomach. This is due to the innervations of appendix which enters the spinal cord, at same level of umbilicus. As the condition progresses, the pain becomes localized at the right lower abdominal quadrant. [4]

In most cases of appendicitis, McBurney’s sign is commonly used to make the diagnosis of acute appendicitis. It is described as deep tenderness felt at the McBurney’s point. It is the point located over the right abdominal side that is one-third of the measured distance from anterior superior iliac spine up to the umbilicus. Also, abdominal tenderness, specifically localized to this point, is indicative of inflammation that is no longer contained within the peritoneum lining. [9]

However, the location of pain varies among individuals based on their age and anatomical position of their appendix. For example, pregnant women and young children may experience appendix pain in different body parts. [5]

For more info : appendix location

Illustration of laparoscopic appendectomy
Illustration of laparoscopic appendectomy
Open Appendectomy
Open Appendectomy

Appendix Pain Treatment and Surgery

Preoperative Stage

1. Medications

  • Intravenous drip: Administered for patient’s hydration
  • Antibiotics: Used to treat and reduce infection within the abdomen. Also, it is administered to prevent postoperative complications. Examples are metronidazole and cefuroxime.
  • Pain medications: This is given together with antibiotics before surgery.
  • Antiemetics: To treat nausea or vomiting which is experienced by most patients with appendicitis.

2. Other preoperative procedures:

  • Nothing per orem (NPO): The patient is not allowed to drink or eat prior to surgery.
  • Shaving of abdominal hair
  • Induction of anesthesia: If the patient has been on NPO for the past six hours, general anesthesia is induced. On the otherhand, if this is not the case, spinal anesthesia is given instead. [4]

Perioperative Stage

1. Laparoscopic Surgery (Keyhole surgery)

  • This involves the insertion of a laparoscope (thin tube with a camera) and three small incisions in the abdomen.
  • With the laparoscope, the surgeon is able to visualize the abdominal cavity through the television screen.
  • In this procedure, the appendix is located with the laparoscope and removed through the use of surgical instruments.
  • The incisions are then closed with stitches or small paper tapes. Then, these are covered with waterproof and sterile dressings. [2]

2. Open appendectomy

  • This technique is used when the appendix has been ruptured, a presence of abscess or tumors, spread infection, history of previous abdominal surgery, and for women who are in third trimester of pregnancy.
  • Traditional appendectomy requires larger incisions to facilitate cleaning of the abdominal cavity. [10]


Postoperative Stage

1. Diet

  • When the patient is fully awake, the patient will be given clear liquids.
  • After some days, the patient will be back to regular diet. This is to promote proper functioning of the intestines.

2. Movement/Activity

  • Post-operatively, the patient is advised to limit movement. Usually, movement should be restricted within the first three to five days following the surgery.
  • The patient can sit on the edge of the bed periodically.
  • Ambulation is also encouraged.
  • When coughing, laughing, or doing other movements, the patient should be taught to properly support the abdomen.
  • Rest as much as possible to promote healing of surgical wound.

3. Medications

  • Pain medication
  • Antibiotics

4. Complementary and alternative treatment

  • Done to help patient control pain.
  • Guided imagery: This is done by closing eyes and imagining about a favourite place or happy memories.
  • Distracting activities: Chatting with friends, listening to music, watching movies [2, 4, 5]

Points to Consider

Appendicitis is a serious medical condition. Therefore, it is important to recognize its signs and symptoms, particularly the appendix pain. Prompt surgical intervention is required to ensure faster recovery. If the intervention is delayed or not given, this may result to certain complications such as peritonitis, which is life threatening.

References:

1. http://www.veria.com/healing/appendix-pain-the-causes-and-dangers/?id=618

2. http://www.southerncross.co.nz/AboutTheGroup/HealthResources/MedicalLibrary/tabid/178/vw/1/ItemID/93/Appendicitis---symptoms-diagnosis-surgery-recovery.aspx

3. http://www.ehow.com/about_5082489_signs-appendix-pain.html

4. https://en.wikipedia.org/wiki/Appendicitis

5. http://www.mayoclinic.com/health/appendicitis/DS00274/DSECTION=causes

6. http://www.medicinenet.com/appendicitis/page2.htm

7. http://bodyandhealth.canada.com/channel_condition_info_details.asp?disease_id=238&channel_id=9&relation_id=10860

8. http://www.webmd.com/digestive-disorders/digestive-diseases-appendicitis

9. https://en.wikipedia.org/wiki/McBurney%27s_point

10. http://www.medicalnewstoday.com/articles/158806.php

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    Newguy 2 years ago

    Thanks for the information, extremely helpful!