Understanding Appendicitis: Causes, Symptoms, and Management

Appendicitis is the inflammation of the appendix, a small pouch attached to the large intestine. It is commonly caused by obstruction of the appendix lumen, which leads to bacterial infection and, if untreated, can result in perforation and serious complications.

🔍 Causes of Appendicitis

The primary trigger is obstruction of the appendix, which allows bacteria to multiply and cause inflammation. Common causes include:

Fecalith – hardened stool blocking the appendix (most common)

Lymphoid hyperplasia – enlarged lymphoid tissue, especially in children and young adults

Rare causes – parasites or tumors


⚠️ Clinical Features

Appendicitis typically presents with a combination of pain, gastrointestinal symptoms, and specific physical signs.

1. Pain (Classic Pattern)

Begins as periumbilical pain (around the navel)

Migrates to the right lower quadrant (RLQ), often localized at McBurney’s point


2. Associated Symptoms

Nausea and vomiting

Loss of appetite (anorexia)

Low-grade fever


3. Physical Signs

RLQ tenderness

Rebound tenderness indicating peritoneal irritation

Guarding – involuntary abdominal muscle contraction


Special Signs

Rovsing’s sign: RLQ pain when the left lower quadrant (LLQ) is pressed

Psoas sign: Pain when extending the hip

Obturator sign: Pain on internal rotation of a flexed hip


🧪 Investigations

Accurate diagnosis often combines laboratory tests and imaging:

Full blood count (FBC): Leukocytosis (high white blood cells)

Urinalysis: To exclude urinary tract infection

Ultrasound: First-line imaging, especially in children and pregnant women

CT scan: Most accurate, used when the diagnosis is unclear


🚨 Complications

If untreated, appendicitis can lead to:

Perforation, causing peritonitis

Abscess formation

Sepsis – potentially life-threatening systemic infection


💊 Management

1. Initial Care

Intravenous (IV) fluids

Analgesics for pain

Antibiotics (e.g., ceftriaxone + metronidazole)


2. Definitive Treatment

Appendectomy – surgical removal of the appendix

Can be open or laparoscopic


⚡ Key Points for Exams and Clinical Practice

Pain migration from the periumbilical area to RLQ is a key diagnostic clue

Anorexia is a common early symptom

Always rule out alternative diagnoses in females:

Ectopic pregnancy

Urinary tract infection (UTI)

Gastroenteritis



🧠 Quick Mnemonic: “MANTRELS”

Migration of pain

Anorexia

Nausea/vomiting

Tenderness in RLQ

Rebound pain

Elevated temperature

Leukocytosis

Shift to left (increase)