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Appendicitis

What is appendicitis?

Appendicitis is an irritation, inflammation, and infection of the appendix (a narrow, hollow tube that branches off the large intestine). The appendix functions as a part of the immune system during the first few years of life. After this time period, the appendix stops functioning and other organs continue helping fight infection. Appendicitis is the most common cause of emergency surgery in childhood.

What causes appendicitis?

Appendicitis occurs when the interior of the appendix becomes filled with something that causes it to swell, such as mucus, stool, or parasites. The appendix then becomes irritated and inflamed. The blood supply to the appendix is cut off as the swelling and irritation increase. Adequate blood flow is necessary for a body part to remain healthy. When the blood flow is reduced, the appendix starts to die. Rupture (or perforation) occurs as holes develop in the walls of the appendix, allowing stool, mucus, and other substances to leak through and get inside the abdomen. An infection inside the abdomen known as peritonitis occurs when the appendix perforates.

What are the risk factors for appendicitis?

Appendicitis affects 7 percent to 8 percent of the US population and is the most common reason for a child to need emergency abdominal surgery.

Most cases of appendicitis occur between the ages of 10 and 30 years. Having a family history of appendicitis may increase a child's risk for the illness, especially in males, and having cystic fibrosis also seems to put a child at higher risk.

Why is appendicitis a concern?

An irritated appendix can rapidly turn into an infected and ruptured appendix, sometimes within hours. A ruptured appendix can be life threatening. When the appendix ruptures, bacteria infect the organs inside the abdominal cavity, causing peritonitis. The bacterial infection can spread very quickly and be difficult to treat if diagnosis is delayed.

What are the symptoms of appendicitis?

The following are the most common symptoms of appendicitis. However, each child may experience symptoms differently. Symptoms may include:

When should your child's physician be called?

Since an infected appendix can rupture and be a life-threatening problem, please call your physician immediately if you think your child has appendicitis.

How is appendicitis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for appendicitis may include:

Other tests may include:

Symptoms of appendicitis may resemble other conditions or medical problems. Consult your physician for a diagnosis.

Treatment for appendicitis:

Specific treatment for appendicitis will be determined by your child's physician based on the following:

Because of the likelihood of the appendix rupturing and causing a severe, life-threatening infection, physicians will recommend that the appendix be removed with an operation.

The appendix may be removed in two ways:

After surgery, children are not allowed to eat or drink anything for a specified period of time so the intestine can heal. Fluids are given into the bloodstream through small plastic tubes called IVs until your child is allowed to begin drinking liquids. Your child will also receive antibiotics and medications to help him/her feel comfortable through the IV. Eventually, children will be allowed to drink clear liquids (such as water, sports drinks like Gatorade® or PowerAde®, or apple juice), and then gradually advance to solid foods.

A child whose appendix ruptured will have to stay in the hospital longer than the child whose appendix was removed before it ruptured. Some children will need to take antibiotics by mouth for a period of time specified by the physician after they go home.

What happens after my child leaves the hospital?

Your physician will generally recommend that your child not do any heavy lifting, play contact sports, or "rough-house" for several weeks after the operation. If a drain is still in place when your child goes home, he/she should not take a tub bath or go swimming until the drain is removed.

Your child may need to take antibiotics at home to help fight the infection in the abdomen.

You will be given a prescription for pain medication for your child to take at home to help him/her feel comfortable. Some pain medications can make a child constipated, so ask your physician or pharmacist about any side effects the medication might have. Moving around after surgery rather than lying in bed can help prevent constipation. Drinking fruit juices and eating fruits, whole grain cereals and breads, and vegetables after being advanced to solid foods can help with constipation as well.

Most children who have their appendix removed will have no long-term problems.

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