16-year-old Manny Correa is admitted to the pediatric inpatient unit from the urgent care clinic.
Manny’s father George brought him to the clinic after Manny experienced pain around his belly button for the past 24 hours.
An abdominal ultrasound confirmed an inflamed appendix. Manny is scheduled for an appendectomy today.
Appendicitis is a condition where the appendix, a finger-like projection that hangs off of the cecum of the large intestine, becomes obstructed and inflamed.
Appendicitis can be caused by lymphoid hyperplasia, where overgrown lymphoid follicles obstruct the appendix, or when a hard lump of stool called a fecalith, a tumor, or even parasites like pinworms cause an obstruction, resulting in appendicitis.
Appendicitis is more common in the second and third decades of life, with the highest incidence between the ages of 10 and 19.
It is more common in men than in women.
Now, when the appendix becomes obstructed, mucosal secretions and the bacteria that normally live in the appendix build up inside, causing the appendix to expand and press against the visceral nerve fibers, resulting in pain that is often felt in the periumbilical area.
Multiplication of bacteria inside the appendix leads to inflammation, which is accompanied by fever, anorexia, nausea, and sometimes vomiting.
Eventually, the appendix starts to irritate the nearby parietal membrane lining the walls of the abdominal cavity, causing the pain to intensify and migrate to the right lower quadrant, an area known as McBurney’s point, which is located 1.5 to 2 inches from the navel to the anterior superior iliac spine.
Palpating McBurney’s point and quickly releasing pressure will demonstrate rebound tenderness, and the person may show guarding, where their abdominal muscles tense up when pressed in an attempt to avoid pain.
