Dr. Buck Parker is licensed in Florida, Colorado, Wyoming, Utah, and Michigan. He is welcoming new patients on his HealthTap Virtual Practice!
What is Appendicitis?
Appendicitis is a blockage and subsequent infection of the Appendix. The appendix is a small tubular structure that is connected to the right side of the colon. It’s about 0.5 inches wide by 5–8 inches long and the lumen, or inside of the tube, is connected to the colon.
Appendicitis develops when the base of this tube gets blocked by stool or food or bacteria. Bacteria live in our GI tract which includes the colon and appendix and the job of the bacteria is to proliferate. So, if the base of the appendix gets blocked, and there are bacteria in there, the bacteria multiply and sooner or later begin to stretch the appendix. That’s when we start to feel pain.
When and where you feel pain
The stretch of the appendix does not actually cause us to feel pain right where the appendix lives (which by the way is in the right lower portion of our abdomen). But rather we start to feel pain around the umbilicus (belly button) area first. It is usually a gnawing or crampy pain that may come and go. Once the bacteria starts to grow through the wall of the appendix, the appendix is now considered to be infected. Once the appendix is infected, we start to feel the pain right where the appendix lives, which again, is the right lower abdomen (doctors call it the RLQ or the Right Lower Quadrant).
Of course, an important thing to know is how long the process takes. It generally takes less than 24 hours from when the base of the appendix becomes blocked, to when we feel the pain in the right lower quadrant. Some other symptoms that we may or may not develop are fevers, chills, nausea, vomiting and even diarrhea at times. Other studies say patients develop “anorexia” as well. In my clinical practice, I’ve found this to often be correct, but not always.
Is it perforated?
If the bacteria proliferates enough, it can actually break open the appendix and spill stool into the abdomen. But, this is generally when the infection is let go longer than 48–72 hours. It happens more frequently in kids and elderly adults. The kids have a more difficult time communicating their symptoms and thus, are diagnosed after a longer infection period. Elderly adults have less pain in general, which makes it more difficult to diagnose them as well after their appendix has been infected. When the appendix does burst there is a higher risk of becoming very sick, but this does not happen frequently, and if treated most people have very good outcomes living with few complications.
Do I truly have appendicitis?
So, the question I get a lot is “do I have Appendicitis”. Now that you know how we get appendicitis, you probably can guess the questions I ask a patient. Do you have abdominal pain? Is it in the “RLQ”? When did it start? Do you have nausea? Vomiting? Fevers & chills? If the patient answers that the pain is in the right lower quadrant, plus any of the other symptoms, then I generally recommend the patient sees a physician for a physical exam. The physical exam from a doctor will determine if a further investigation (labs & possibly CT scans) is required.
If you or a family member develops a fairly sudden onset (less than 24 hrs) of right lower quadrant abdominal pain that does not improve, it’s best to consult with a HealthTap physician or go to the nearest ER as soon as possible.
