Appendicitis – causes, symptoms, diagnosis, treatment & pathology

The appendix is the little one-ended tube
that’s attached to the cecum of the large intestine, sometimes it’s called the vermiform
appendix, where vermiform means “worm-shaped”, so, that should paint a pretty clear picture
of what it looks like. This odd, yet kinda cute little worm-like structure’s function
is actually unknown, though some theories suggest it might be a “safe-house” for
the gut flora, and some evidence seems to suggests it plays a part in the lymphatic
and immune system; other, arguably more cynical viewpoints maintain that it’s just a useless
vestigial organ from our ancestors. Whatever the case, the fact remains, it’s pretty
talented at getting inflamed and causing abdominal pain, a condition known as appendicitis, as
much as 10% of the population develops appendicitis, and it’s the most common surgical emergency
of the abdomen. Since the appendix is a hollow tube, the most
common cause of inflammation is something getting stuck in or obstructing that tube,
like a fecalith, a hardened lump of fecal matter that finds it’s way into the the
lumen of the appendix and wedges itself there. It could also be other things though, like
seeds that weren’t digested, or even pinworm infections, which are intestinal parasites.
Another cause of obstruction, especially in children and adolescents, is lymphoid follicle
growth, also known as lymphoid hyperplasia. Lymphoid follicles are dense collections of
lymphocytes that get to their maximum size in the appendix during adolescence. Sometimes
this growth can literally obstruct the tube. Also, when exposed to viral infections like
adenovirus, measles, or even after immunizations, the immune system ramps up and these follicles
can grow as well. Whatever the obstruction is, now this appendix
is plugged up, right? Well, the intestinal lumen, including the appendix, is always secreting
mucus and fluids from its mucosa to keep pathogens from entering the bloodstream and also to
keep the tissue moist. Even when it’s plugged, the appendix keeps secreting as usual. When
this happens, fluid and mucus builds up, which increases the pressure in the appendix, and
just like when you fill up a water balloon, it gets bigger and physically pushes ons the
afferent visceral nerve fibers nearby, causing abdominal pain. Along with that, the flora
and bacteria in the gut are now trapped, and intestinal bacteria that are usually kept
in check in the gut, like E. coli and Bacteroides fragilis are now free to multiply. This causes
the immune system to recruit white blood cells and pus starts to accumulate in the appendix.
This activation of the immune system can be seen in the lab as an increase in the serum
white blood cell count. Patients might also develop a fever in response to the infection,
which in combination with right lower quadrant abdominal pain at the point roughly where
the appendix is, known as known as mcburney’s point, is a super important sign for identifying
appendicitis. Also, along with fever, other classic symptoms include nausea and vomiting. Now if obstruction persists, the pressure
in the appendix increases even more. At a certain point, as the pressure keeps growing
and it continues to swell up, it pushes on and compresses the small blood vessels that
supply the appendix with blood and oxygen. Without oxygen, the cells in the walls of
the appendix become ischemic and eventually die. Since these cells were responsible for
secreting mucus and keeping bacteria out, now the growing colony of bacteria can invade
the wall of the appendix. As more cells die, the appendiceal walls become weaker and weaker
and for a small proportion of patients, to the point where the appendix ruptures. Rupture
of an infected appendix allows the bacteria to escape the appendix and get into the peritoneum,
and patients often experience peritonitis with rebound tenderness, meaning pain when
pressure is taken off, again around mcburney’s point. Patients might also have some abdominal
guarding, where their abdominal muscles tense up when pressed to try and avoid pain. The
most common complication with a ruptured appendix is pus and fluid gets out and forms an abcess
around the appendix, called a periappendiceal abscess. Sometimes subphrenic abscesses might
also form, these would be tiny abscesses below the diaphragm but above the liver or spleen. The standard treatment for appendicitis is
appendectomy, which is surgical removal of the appendix along with antibiotics. If patients
have abscesses these are also important to surgically drain. Removing the appendix isn’t
known to have any negative side effects, and sometimes it’s removed if the surgeons are
already doing an abdominal surgery for some other reason just to avoid an appendicitis
down the road!

100 thoughts on “Appendicitis – causes, symptoms, diagnosis, treatment & pathology”

  1. I have pain and swelling in my abdomen. I've been feeling nauseous lately and the pain occasionally comes and goes. What do I do?

  2. Excellent video!
    But is there any altenative way of treating Appendicitis other than surgery?? Especially when it's in tenderness pain?

  3. Why you will get appendix when you work immediately when you are full. The intestine will behave by contracting as a result to hold your food properly due to motion or heaviness to prevent hitting other organs or protecting the stomach itself because of this somehow the intestine contract to prevent the fluid to move slowly or avoid unstable food digested fluid or stomach food itself motion due to this some intestine waste often inflates, stretch other regions of the intestine some debris that some how goes to the appendix or due to the intestinal contraction happens more frequently bacteria starts to get in the appendix or gets an allergic reaction which the appendix will inflate due to gas trap or bacterial infection the appendix will grow and rapture

  4. Mine had to be removed last October…but I could go home after three days in hospital and didn't really feel pain afterwards.

  5. Two years ago I went to the hospital quite a few times and took notes on each day. In November I had a lot of bleeding from the rectum. I've been having this problem on and off for quite some time, and have been seeing many doctors for it because it's always determined not to come from hemorrhoids. It was especially bad this time but there wasn't any pain. I was told to come back if I experienced pain. Early October I had lower back pain, and abdominal pain but they just gave me morphine and told me it was probably gastritis and to come back if pain worsens or is accompanied by fever. The next day I woke up at 3AM with a temp of 100.5 and more pain, pretty severe. I went back and they gave me more morphine (:/) and ran some more tests. After a CT, I had a doctor come in and ask me if I've had any surgeries and I haven't. He left for a while and came back with a radiographer where they informed me I had an obstruction. Of course, I was worried but they didn't quite explain why or what they think it was or what it really even meant. After 16 hours and doctors and surgeons coming in and out, a surgeon came in and told me that they were "deciding against surgery". At that point I didn't even know they were deliberating on it so I was shocked to say the least. They told me to check with my GI.
    I've had a colonoscopy and a endoscopy since then which seemed to be fine. But I still get these same symptoms off and on. Lots of blood, a few days later I'm very sick. Actually, last month it cycled again but the fever was higher (103.5).
    Anyways, I'm seeing my third GI and when I told her about all this, she was acting like she didn't believe me. She was clicking through my files and said it wasn't there, but I looked at her screen and saw the file myself and pointed at it. It was only then that I learned I had a "distended appendix?" She clicked away and said "if they were concerned they wouldn't have sent you home." and gave me my 5th medication for IBS pain (all the others failing to help).
    Does this mean I had appendicitis? Can appendicitis just go away? Can it flair up? I'm getting desperate for answers. I've gotten medication for IBS and Crohns and nothing has worked and I'm sick of being sick.

  6. My appendix burst a few days ago, felt nothing until the fever and vomiting began to happen and had it removed, I’ve now been in the hospital for 7 days with a tube hanging from my body

  7. "Whatever the case may be…. it's pretty talented at getting inflamed and causing abdominal pain" This quote had me in stitches for some reason!

  8. One thing that happened to me was the pain mimicked ovulation pain—it started more as a back pain, which I was so used to, I ignored it. I even had a dressage lesson (riding horses) during what was an appendicitis attack, and it ruptured the next day(riding did not cause the rupture). The pain I had was like a gas pain behind my navel first, and lower back. Once it ruptured, it then moved to the lower right side and mother of god, that whole experience was the most pain I've had, and my pain threshold is very high. Upon diagnosis and surgery, the surgeon said my appendix ruptured with such force, it split in 2. Thank GOD I had a good surgeon and medical team, and I loathe antibiotics so the stuff they put me on ,while it made me so sick, it killed pretty much everything.

  9. I went to immediate Care cuz I thought I had a stomach bug or something but nope I had appendicitis and I had to get rushed in an ambulance from immediate Care to the hospital and I had to get surgery. It's been 2 days after my surgery and im back home now and recovering. Luckily it didn't burst and the doctors were able to get it out before it did. Im feeling better and starting to move around a lot more now 🙂 I recommend that if you have constant pain on your right side of your stomach, get it checked out immediately!

  10. As soon we become of age like 15 or something we should all just get them removed from our body’s

  11. I had this about 13 years ago. My appendix burst and had an emergency surgery. I suspect it's all the gum and plastic I swallowed as a kid. All I recall was the pain…no word can describe it!

  12. My mom has appendicitis and she’s too stubborn. She says the pain goes away then comes back and it feels like a period cramp kind of. She was in the hospital last night but she doesn’t want to go back. In the hospital, she didn’t feel any pain but now she is home the pain comes and goes. What do I do?

  13. i am in sharp pain right now and i think i have to go to the hospital immediately. does anyone know about the bills?

  14. I wish youtube makes a simple donating tools so people could just send money through youtube to support their favorite channels

  15. Deadass i just had gotten out surgery for appendicitis. The pain is unbearable if anyone has it go to the hospital!

  16. How long will it take to burst? I experienced a stomach ache last night on the right side of my abdomin and it is really really painful. I honestly dont like to undergo operation bcz i dont want to have scars. Is there a way to stop the swelling and go back to normal?

  17. Thanks that’s really comforting, my mum is in hospital right now and might have appendicitis. It obviously isn’t too serious.


  19. Mine is right now being treated with a heavy dose of antibiotics. It's a new trial study which has promising results. 70 percent success rate. After all, who wants cut open and risk a serious infection?

  20. Am I the only person who Had their Appendix Explode? ;-; I got surgery On September 5 and well now it's hurts to laugh, cough, and sneeze ;-;

  21. My brother is currently undergoing appendectomy, this video helped me calm down… don't think I'll be able to sleep, but it is well explained and easy. Thank you very much.

  22. I started to feel the pain in my belly after my workout yesterday. It was so intense I almost couldn't walk to the bus stop. And I feel it everytime I move too much, I have been getting nautious lately and getting headaches too. My dad says it may be an appendicitis, but we're gonna see if I get sick. It might just be really terrible cramps.

  23. How do I single down between this and a hernia? This video is really informative though because that belly button pain is REAL and I understand why that low ab area gets mad swollen (with the whole vessels explanation). I've been in pain for 6 months though. 🙁 About to hit the ER or a doctor soon, just hard wasting money on tests to be told "everything looks normal" try a different doctor.

  24. This video is amazing for understanding the condition better. Thank you for that. The only thing that should've been mentioned is the fact that symptoms might vary from a person to a person because of some reasons. Other than that, truly a great video

  25. These videos are so very helpful, and I have been using them for my patho class. I wish I had found out sooner tho ? you guys are amazing and thank you so much for making life much easier ❤️

  26. mine burst and i was in hospital for 4 months

    i nearly died cause of that little fucker……….

    hands down worst moment of my life.

  27. 3 days I noticed my stomach being inflamed, I thought it might be that I’m getting my mensturation soon, haven’t gotten it, yesterday I started feeling a bit dizzy, and now today I have really bad diarrhea, and now my lower right side of my stomach hurts, but it’s more like an uncomfortable pain, than a sharp pain, more like a menstrual pain but on only one side, never have I had that, always get it on all my lower body, not on a specific part, I also did heavy heavy weight lifting last night? Ugh someone help

  28. I had my appendix removed when I was nine and the pain was so unbearable that I was screaming like I was being tortured in a horror movie. Once I was hospitalized for this reason; I was having so much blood work done that I would have a sense of dread when the nurses arrived in my room. I did feel like a piece of shit after the surgery; but I was eventually able to get caught up on my weight.

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