121 HEALTH

Bleeding in the Digestive

What are the signs of bleeding in the digestive tract?
What causes bleeding in the digestive tract?
How is bleeding in the digestive tract diagnosed?
How is bleeding in the digestive tract treated?
Points to Remember
Hope through Research
For More Information

Bleeding in the digestive tract is a symptom of a disease rather than a disease itself. A number of different conditions can cause bleeding. Most causes of bleeding are related to conditions that can be cured or controlled, such as ulcers or hemorrhoids. Some causes of bleeding may be life threatening.
Locating the source of bleeding is important. Different conditions cause bleeding in the upper digestive tract and the lower digestive tract. The upper digestive tract includes the esophagus, stomach, and upper portion of the small intestine, also called the duodenum. The lower digestive tract includes the lower portion of the small intestine; large intestine, which includes the colon and rectum; and anus.
Drawing of the digestive tract. The esophagus, stomach, duodenum, small intestine, colon, rectum, and anus are labeled. The colon is shaded.

The digestive tract

What are the signs of bleeding in the digestive tract?

The signs of bleeding in the digestive tract depend on the site and severity of bleeding.
Signs of bleeding in the upper digestive tract include

bright red blood in vomit
vomit that looks like coffee grounds
black or tarry stool
dark blood mixed with stool
stool mixed or coated with bright red blood

Signs of bleeding in the lower digestive tract include

black or tarry stool
dark blood mixed with stool
stool mixed or coated with bright red blood

Sudden, severe bleeding is called acute bleeding. If acute bleeding occurs, symptoms may include

weakness
dizziness or faintness
shortness of breath
crampy abdominal pain
diarrhea
paleness

A person with acute bleeding may go into shock, experiencing a rapid pulse, a drop in blood pressure, and difficulty producing urine.
Light bleeding that continues for a long time or starts and stops is called chronic bleeding. If bleeding is chronic, a person may notice that fatigue, lethargy, and shortness of breath develop over time. Chronic blood loss can also lead to anemia, a condition in which the blood's iron-rich substance, hemoglobin, is diminished.
A person may not notice a small amount of bleeding in the digestive tract. This type of bleeding is called occult bleeding. Simple tests can detect occult blood in the stool.

What causes bleeding in the digestive tract?

A variety of conditions can cause bleeding in the digestive tract. Causes of bleeding in the upper digestive tract include the following:

Peptic ulcers. Helicobacter pylori (H. pylori) infections and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are common causes of peptic ulcers.
Esophageal varices. Varices, or enlarged veins, located at the lower end of the esophagus may rupture and bleed massively. Cirrhosis is the most common cause of esophageal varices.
Mallory-Weiss tears. These tears in the lining of the esophagus usually result from vomiting. Increased pressure in the abdomen from coughing, hiatal hernia, or childbirth can also cause tears.
Gastritis. NSAIDs and other drugs, infections, Crohn's disease, illnesses, and injuries can cause gastritis—inflammation and ulcers in the lining of the stomach.
Esophagitis. Gastroesophageal reflux disease (GERD) is the most common cause of esophagitis—inflammation and ulcers in the lining of the esophagus. In GERD, the muscle between the esophagus and stomach fails to close properly, allowing food and stomach juices to flow back into the esophagus.
Benign tumors and cancer. A benign tumor is an abnormal tissue growth that is not cancerous. Benign tumors and cancer in the esophagus, stomach, or duodenum may cause bleeding.

Causes of bleeding in the lower digestive tract include the following:

Diverticular disease. This disease is caused by diverticula—pouches in the colon wall.
Colitis. Infections, diseases such as Crohn's disease, lack of blood flow to the colon, and radiation can cause colitis—inflammation of the colon.
Hemorrhoids or fissures. Hemorrhoids are enlarged veins in the anus or rectum that can rupture and bleed. Fissures, or ulcers, are cuts or tears in the anal area.
Angiodysplasia. Aging causes angiodysplasia—abnormalities in the blood vessels of the intestine.
Polyps or cancer. Benign growths or polyps in the colon are common and may lead to cancer. Colorectal cancer is the third most common cancer in the United States and often causes occult bleeding.¹

¹ Common cancer types. National Cancer Institute website. www.cancer.gov/cancertopics/commoncancers#1. Updated May 7, 2009. Accessed October 26, 2009.

How is bleeding in the digestive tract diagnosed?

The first step in diagnosing bleeding in the digestive tract is locating the site of the bleeding. The doctor will take the patient's complete medical history and perform a physical examination. Symptoms such as changes in bowel habits, black or red stools, and pain or tenderness in the abdomen may tell the doctor which area of the digestive tract is bleeding.
The doctor may need to test the stool for blood. Iron supplements, bismuth subsalicylate (Pepto-Bismol), or certain foods such as beets can give the stool the same appearance as bleeding from the digestive tract. Stool tests can also show bleeding that is not visible to the patient.
A blood test can help determine the extent of the bleeding and whether the patient is anemic.
Nasogastric lavage is a procedure that can be used to determine whether the bleeding is in the upper or lower digestive tract. With nasogastric lavage, a tube is inserted through the nose and into the stomach. The contents of the stomach are removed through the tube. If the stomach contains bile and does not contain blood, the bleeding either has stopped or is likely in the lower digestive tract.

Endoscopy

Endoscopy is the most common method for finding the source of bleeding in the digestive tract. An endoscope is a flexible tube with a small camera on the end. The doctor inserts the endoscope through the patient's mouth to view the esophagus, stomach, and duodenum. This examination is called esophagogastroduodenoscopy (EGD). An endoscope can also be inserted through the rectum to view the colon. This procedure is called colonoscopy. The doctor can use the endoscope to do a biopsy, which involves collecting small samples of tissue for examination with a microscope.
Bleeding that cannot be found with endoscopy is called obscure bleeding. The doctor may repeat the endoscopy or use other procedures to find the cause of obscure bleeding.

Enteroscopy

Enteroscopy is an examination of the small intestine. Because traditional endoscopes cannot reach the small intestine, special endoscopes are used for enteroscopy.
Enteroscopy procedures include

Push enteroscopy. A long endoscope is used to examine the upper portion of the small intestine.
Double-balloon enteroscopy. Balloons are mounted on the endoscope to help the endoscope move through the entire small intestine.
Capsule endoscopy. The person swallows a capsule containing a tiny camera. The camera transmits images to a video monitor as the capsule passes through the digestive tract. This procedure is designed to examine the small intestine, but it also allows the doctor to examine the rest of the digestive tract.

Other Procedures

Several other methods can help locate the source of bleeding:

Barium x rays. Barium is a contrast material that makes the digestive tract visible in an x ray. A liquid containing barium is either swallowed or inserted into the rectum. Barium x rays are less accurate than endoscopy and may interfere with other diagnostic techniques.
Radionuclide scanning. The doctor injects small amounts of radioactive material into the person's vein. A special camera, similar to an x-ray machine, can detect this radiation and create images of blood flow in the digestive tract. Radionuclide scanning is sensitive enough to detect very slow bleeding, but it is not as accurate as other procedures.
Angiography. A dye is injected into the person's vein to make blood vessels visible in x-ray or computerized tomography (CT) scans. Dye leaks out of the blood vessels at the bleeding site. In some cases, the doctor can use angiography to inject medicine or other material into blood vessels to try to stop the bleeding.
Exploratory laparotomy. If other methods cannot locate the source of the bleeding, a surgical procedure may be necessary to examine the digestive tract.

How is bleeding in the digestive tract treated?

Endoscopy can be used to stop bleeding in the digestive tract. A doctor can insert tools through the endoscope to

inject chemicals into the bleeding site
treat the bleeding site and surrounding tissue with a heat probe, electric current, or laser
close affected blood vessels with a band or clip

Endoscopy does not always control bleeding. Angiography can be used to inject medicine or other material into blood vessels to control some types of bleeding. If endoscopy and angiography do not work, the patient may need other treatments or surgery to stop the bleeding.
To prevent bleeding in the future, doctors can treat the conditions that cause bleeding, such as

H. pylori and other infections
GERD
ulcers
hemorrhoids
polyps
inflammatory bowel diseases

Points to Remember

Bleeding in the digestive tract is a symptom of a disease rather than a disease itself.
A number of different conditions can cause bleeding in the digestive tract.
Finding the location and cause of the bleeding is important.
Most causes of bleeding can be cured or controlled.
Endoscopy is the most common tool for diagnosing and treating bleeding in the digestive tract.

Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsors research to improve treatment for patients with digestive diseases that cause bleeding in the digestive tract, including diverticular disease, GERD, and inflammatory bowel diseases.
Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.

For More Information

American College of Gastroenterology
P.O. Box 342260
Bethesda, MD 20827–2260
Phone: 301–263–9000
Internet: www.acg.gi.org

American Gastroenterological Association
National Office
4930 Del Ray Avenue
Bethesda, MD 20814
Phone: 301–654–2055
Fax: 301–654–5920
Email: member@gastro.org
Internet: www.gastro.org

Hepatitis B What Asian and Pacific Islander Americans Need to Know

What is hepatitis B?
What is chronic hepatitis B?
Why are Asian and Pacific Islander Americans at higher risk?
What are the symptoms of chronic hepatitis B?
Who is at risk for hepatitis B?
How can I protect myself and others from hepatitis B?
How can I protect my baby from hepatitis B?
Where can I get more information about hepatitis B?

Did you know that Asian and Pacific Islander Americans and other foreign-born Americans are at higher risk for chronic hepatitis B, which can lead to liver failure and liver cancer?

What is hepatitis B?

Hepatitis B is a liver disease spread through contact with blood, semen, or other body fluids from a person infected with the hepatitis B virus. The disease is most commonly spread from an infected mother to her infant at birth. Hepatitis B is also spread through sex, wound-to-wound contact, and contact with items that may have blood on them, such as shaving razors, toothbrushes, syringes, and tattoo and body piercing needles.
Hepatitis B is not spread through casual contact such as shaking hands or hugging; nor is it spread by sharing food or beverages, by sneezing and coughing, or through breastfeeding.

What is chronic hepatitis B?

Hepatitis B may start as a brief, fl ulike illness. Most healthy adults and children older than 5 completely recover after the body’s immune system gets rid of the virus.
Hepatitis B becomes chronic when the body’s immune system can’t get rid of the virus. Over time, having the virus can lead to inflammation of the liver; scar tissue in the liver, called cirrhosis; or liver cancer. Inflammation is the painful red swelling that results when tissues of the body become infected. Young children and people with weakened immune systems are especially at risk. People who were infected as infants have a 90 percent chance of developing chronic hepatitis B.¹

¹Weinbaum CM, Williams I, Mast EE et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. Morbidity and Mortality Weekly Report Recommendations and Reports. 2008 September 19;57(RR–8):1–20.

Why are Asian and Pacific Islander Americans at higher risk?

Since 1986, a hepatitis B vaccine has been available and should be given to newborns and children in the United States. The vaccine, however, is unavailable—or has only recently become available—in many parts of the world. You are at higher risk for hepatitis B if you or your mother was born in a region of the world where hepatitis B is common, meaning 2 percent or more of the population is chronically infected with the hepatitis B virus.¹ In most Asian and Pacific Island nations, 8 to 16 percent of the population is chronically infected.²

² Custer B, Sullivan SD, Hazlet TK, Iloeje U, Veenstra DL, Kowdley KV. Global epidemiology of hepatitis B virus. Journal of Clinical Gastroenterology. 2004 November;38(10 Suppl 3):S158–S168.

What are the symptoms of chronic hepatitis B?

Hepatitis B is called a “silent killer” because many people have no symptoms, so the disease often progresses unnoticed for years. Unfortunately, many people first learn they have chronic hepatitis B when they develop symptoms of severe liver damage, which include

yellowish eyes and skin, called jaundice
a swollen stomach or ankles
tiredness
nausea
weakness
loss of appetite
weight loss
spiderlike blood vessels, called spider angiomas, that develop on the skin

Who is at risk for hepatitis B?

Anyone can get hepatitis B, but some people are at higher risk, including

people who were born to a mother with hepatitis B
people who have close household contact with someone infected with the hepatitis B virus
people who have lived in parts of the world where hepatitis B is common, including most Asian and Pacific Island nations
people who are exposed to blood or body fluids at work
people on hemodialysis
people whose sex partner(s) has hepatitis B
people who have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
injection drug users
men who have sex with men

May is Hepatitis Awareness Month and Asian American and Pacific Islander Heritage Month

May is Hepatitis Awareness Month and Asian American and Pacific Islander Heritage Month. This year, CDC's Division of Viral Hepatitis is focusing on raising awareness about hepatitis B among Asian Americans and Pacific Islanders (AAPIs) and encouraging AAPIs to talk to their doctors about getting tested for hepatitis B.

What should AAPIs know about Hepatitis B?

Hepatitis B affects 1 in 12 Asians Americans and Pacific Islanders

Hepatitis B is common in many parts of the world, with an estimated 350 million people living with the disease worldwide. In the US, an estimated 1.2 million Americans are infected. However, hepatitis B disproportionately affects Asian Americans and Pacific Islanders because it is especially common in many Asian and Pacific Island countries. While AAPIs make up less than 5% of the total U.S. population, they account for more than 50% of Americans living with chronic hepatitis B.
Hepatitis B is serious
If left untreated, up to 25 percent of people with hepatitis B develop serious liver problems such as cirrhosis and even liver cancer. In the US, chronic hepatitis B infection results in thousands of deaths per year. Liver cancer caused by the hepatitis B virus is a leading cause of cancer deaths among Asian Americans.
As many as 2 in 3 Asian Americans with hepatitis B don't know they are infected
People can live with hepatitis B without having any symptoms or feeling sick. Many people with chronic hepatitis B got infected as infants or young children. It is usually spread when someone comes into contact with blood from someone who has the virus. As many as 2 in 3 AAPIs living with the virus do not know they are infected. Often, people do not know they have hepatitis B until they have been tested.

Who should get tested for Hepatitis B?

Anyone born in Asia or the Pacific Islands (except New Zealand and Australia)
Anyone born in the United States, who was not vaccinated at birth, and has at least one parent born in East or Southeast Asia (except Japan) or the Pacific Islands (except New Zealand and Australia)

Hepatitis B testing identifies people living with chronic hepatitis B so they can get medical care to help prevent serious liver damage. Testing also helps to find other people who may not have hepatitis B, but are at risk for getting infected. This can include people living with someone with hepatitis B.
For more information, talk to a doctor about getting tested for Hepatitis B.

How can I protect myself and others from hepatitis B?

Get tested if you are from an Asian or Pacific Island nation or other region where the hepatitis B virus is common. The sooner you get tested, the sooner you can take steps to protect yourself and others.
A health care provider can test your blood to see if you are currently infected or were infected in the past. If you test positive, your doctor may measure virus and liver enzyme levels in your blood to determine if the virus is active or causing liver injury. The doctor may use ultrasound—a procedure that uses sound waves to create images of the body's internal tissues and organs—to screen for liver cancer, also called hepatocellular carcinoma. You may not need treatment right away, but you will need periodic tests to monitor the health of your liver. Encourage your family members and other close personal contacts to get tested.
Hepatitis B is preventable. Get vaccinated if you have not been infected. The hepatitis B vaccine is given in three shots over 6 months. You must get all three shots to be fully protected. The vaccine is safe for people of all ages, including pregnant women and infants.
If you think you have been recently exposed to the hepatitis B virus, see your doctor right away. The first dose of hepatitis B vaccine combined with hepatitis B immune globulin—an injection of antibodies that temporarily protects against hepatitis B infection—may prevent infection.
No cure exists for hepatitis B, but several medicines are approved for treating chronic hepatitis B. The goal of treatment is to reduce the risk of liver damage, liver cirrhosis, and liver cancer by decreasing liver inflammation and the amount of virus in the body. Current medicines do not completely get rid of the virus, so treatment is often lifelong. People with chronic hepatitis B should avoid alcohol, drugs, supplements, and herbal medicines that may harm the liver.

How can I protect my baby from hepatitis B?

Getting tested for hepatitis B is especially important for pregnant women. If you are not infected, get the vaccine. If you have hepatitis B, make sure the doctor and staff that deliver your baby know so they can minimize your baby’s risk of infection. The hepatitis B vaccine and hepatitis B immune globulin should be given to your baby immediately after birth, greatly reducing the chance of infection.

Where can I get more information about hepatitis B?

Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Viral Hepatitis
1600 Clifton Road, Mailstop G–37
Atlanta, GA 30333
Phone: 1–800–232–4636
TTY: 1–888–232–6348
Fax: 404–718–8588
Email: cdcinfo@cdc.gov
Internet: www.cdc.gov/hepatitis

Appendicitis Symptoms, Causes, Surgery, and Recovery

What is appendicitis?
What is the appendix?
What causes appendicitis?
Who gets appendicitis?
What are the symptoms of appendicitis?
How is appendicitis diagnosed?
How is appendicitis treated?
What are the complications and treatment of a burst appendix?
What if the surgeon finds a normal appendix?
Can appendicitis be treated without surgery?
What should people do if they think they have appendicitis?
Eating, Diet, and Nutrition
Points to Remember
Hope through Research
For More Information

What is appendicitis?

Appendicitis is inflammation of the appendix. Appendicitis is the leading cause of emergency abdominal operations.¹
¹Spirt MJ. Complicated intra-abdominal infections: a focus on appendicitis and diverticulitis.

What is the appendix?

The appendix is a fingerlike pouch attached to the large intestine in the lower right area of the abdomen, the area between the chest and hips. The large intestine is part of the body’s gastrointestinal (GI) tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, helps digest food. The appendix does not appear to have a specific function in the body, and removing it does not seem to affect a person’s health.
The inside of the appendix is called the appendiceal lumen. Normally, mucus created by the appendix travels through the appendiceal lumen and empties into the large intestine. The large intestine absorbs water from stool and changes it from a liquid to a solid form.

The appendix is a fingerlike pouch attached to the large intestine in the lower right area of the abdomen.

What causes appendicitis?

An obstruction, or blockage, of the appendiceal lumen causes appendicitis. Mucus backs up in the appendiceal lumen, causing bacteria that normally live inside the appendix to multiply. As a result, the appendix swells and becomes infected. Sources of blockage include

stool, parasites, or growths that clog the appendiceal lumen
enlarged lymph tissue in the wall of the appendix, caused by infection in the GI tract or elsewhere in the body
inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, long-lasting disorders that cause irritation and ulcers in the GI tract
trauma to the abdomen

An inflamed appendix will likely burst if not removed.

Who gets appendicitis?

Anyone can get appendicitis, although it is more common among people 10 to 30 years old.¹

What are the symptoms of appendicitis?

The symptoms of appendicitis are typically easy for a health care provider to diagnose. The most common symptom of appendicitis is abdominal pain.
Abdominal pain with appendicitis usually

occurs suddenly, often waking a person at night
occurs before other symptoms
begins near the belly button and then moves lower and to the right
is unlike any pain felt before
gets worse in a matter of hours
gets worse when moving around, taking deep breaths, coughing, or sneezing

Other symptoms of appendicitis may include

loss of appetite
nausea
vomiting
constipation or diarrhea
an inability to pass gas
a low-grade fever that follows other symptoms
abdominal swelling
the feeling that passing stool will relieve discomfort

Symptoms vary and can mimic the following conditions that cause abdominal pain:

intestinal obstruction—a partial or total blockage in the intestine that prevents the flow of fluids or solids.
IBD.
pelvic inflammatory disease—an infection of the female reproductive organs.
abdominal adhesions—bands of tissue that form between abdominal tissues and organs. Normally, internal tissues and organs have slippery surfaces that let them shift easily as the body moves. Adhesions cause tissues and organs to stick together.
constipation—a condition in which a person usually has fewer than three bowel movements in a week. The bowel movements may be painful.

Appendicitis is an inflammation of the appendix, a 3 1/2-inch-long tube of tissue that extends from the large intestine. No one is absolutely certain what the function of the appendix is. One thing we do know: We can live without it, without apparent consequences.

Appendicitis is a medical emergency that requires prompt surgery to remove the appendix. Left untreated, an inflamed appendix will eventually burst, or perforate, spilling infectious materials into the abdominal cavity. This can lead to peritonitis, a serious inflammation of the abdominal cavity's lining (the peritoneum) that can be fatal unless it is treated quickly with strong antibiotics.

Sometimes a pus-filled abscess (infection that is walled off from the rest of the body) forms outside the inflamed appendix. Scar tissue then "walls off" the appendix from the rest of the abdomen, preventing infection from spreading. An abscessed appendix is a less urgent situation, but unfortunately, it can't be identified without surgery. For this reason, all cases of appendicitis are treated as emergencies, requiring surgery.

In the U.S., one in 15 people will get appendicitis. Although it can strike at any age, appendicitis is rare under age 2 and most common between ages 10 and 30.

What Are the Symptoms of Appendicitis?

The classic symptoms of appendicitis include:

Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right abdomen. This is usually the first sign.
Loss of appetite
Nausea and/or vomiting soon after abdominal pain begins
Abdominal swelling
Fever of 99-102 degrees Fahrenheit
Inability to pass gas

Almost half the time, other symptoms of appendicitis appear, including:

Dull or sharp pain anywhere in the upper or lower abdomen, back, or rectum
Painful urination
Vomiting that precedes the abdominal pain
Severe cramps
Constipation or diarrhea with gas

If you have any of the mentioned symptoms, seek medical attention immediately since timely diagnosis and treatment is very important. Do not eat, drink, or use any pain remedies, antacids, laxatives, or heating pads, which can cause an inflamed appendix to rupture.

How is appendicitis diagnosed?

A health care provider can diagnose most cases of appendicitis by taking a person’s medical history and performing a physical exam.
If a person does not have the usual symptoms, health care providers may use laboratory and imaging tests to confirm appendicitis. These tests also may help diagnose appendicitis in people who cannot adequately describe their symptoms, such as children or people who are mentally impaired.

Medical History

The health care provider will ask specific questions about symptoms and health history. Answers to these questions will help rule out other conditions. The health care provider will want to know

when the abdominal pain began
the exact location and severity of the pain
when other symptoms appeared
other medical conditions, previous illnesses, and surgical procedures
whether the person uses medications, alcohol, or illegal drugs

Physical Exam

Details about the person’s abdominal pain are key to diagnosing appendicitis. The health care provider will assess the pain by touching or applying pressure to specific areas of the abdomen.
Responses that may indicate appendicitis include

Rovsing’s sign. A health care provider tests for Rovsing’s sign by applying hand pressure to the lower left side of the abdomen. Pain felt on the lower right side of the abdomen upon the release of pressure on the left side indicates the presence of Rovsing’s sign.
Psoas sign. The right psoas muscle runs over the pelvis near the appendix. Flexing this muscle will cause abdominal pain if the appendix is inflamed. A health care provider can check for the psoas sign by applying resistance to the right knee as the patient tries to lift the right thigh while lying down.
Obturator sign. The right obturator muscle also runs near the appendix. A health care provider tests for the obturator sign by asking the patient to lie down with the right leg bent at the knee. Moving the bent knee left and right requires flexing the obturator muscle and will cause abdominal pain if the appendix is inflamed.
Guarding. Guarding occurs when a person subconsciously tenses the abdominal muscles during an exam. Voluntary guarding occurs the moment the health care provider’s hand touches the abdomen. Involuntary guarding occurs before the health care provider actually makes contact and is a sign the appendix is inflamed.
Rebound tenderness. A health care provider tests for rebound tenderness by applying hand pressure to a person’s lower right abdomen and then letting go. Pain felt upon the release of the pressure indicates rebound tenderness and is a sign the appendix is inflamed. A person may also experience rebound tenderness as pain when the abdomen is jarred—for example, when a person bumps into something or goes over a bump in a car.

Women of childbearing age may be asked to undergo a pelvic exam to rule out gynecological conditions, which sometimes cause abdominal pain similar to appendicitis.
The health care provider also may examine the rectum, which can be tender from appendicitis.

Laboratory Tests

Laboratory tests can help confirm the diagnosis of appendicitis or find other causes of abdominal pain.

Blood tests. A blood test involves drawing a person’s blood at a health care provider’s office or a commercial facility and sending the sample to a laboratory for analysis. Blood tests can show signs of infection, such as a high white blood cell count. Blood tests also may show dehydration or fluid and electrolyte imbalances. Electrolytes are chemicals in the body fluids, including sodium, potassium, magnesium, and chloride.
Urinalysis. Urinalysis is testing of a urine sample. The urine sample is collected in a special container in a health care provider’s office, a commercial facility, or a hospital and can be tested in the same location or sent to a laboratory for analysis. Urinalysis is used to rule out a urinary tract infection or a kidney stone.
Pregnancy test. Health care providers also may order a pregnancy test for women, which can be done through a blood or urine test.

Imaging Tests

Imaging tests can confirm the diagnosis of appendicitis or find other causes of abdominal pain.

Abdominal ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The transducer can be moved to different angles to make it possible to examine different organs. In abdominal ultrasound, the health care provider applies gel to the patient’s abdomen and moves a hand-held transducer over the skin. The gel allows the transducer to glide easily, and it improves the transmission of the signals. The procedure is performed in a health care provider’s office, an outpatient center, or a hospital by a specially trained technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging; anesthesia is not needed. Abdominal ultrasound creates images of the appendix and can show signs of inflammation, a burst appendix, a blockage in the appendiceal lumen, and other sources of abdominal pain. Ultrasound is the first imaging test performed for suspected appendicitis in infants, children, young adults, and pregnant women.
Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of the body’s internal organs and soft tissues without using x rays. The procedure is performed in an outpatient center or a hospital by a specially trained technician, and the images are interpreted by a radiologist. Anesthesia is not needed, though children and people with a fear of confined spaces may receive light sedation, taken by mouth. An MRI may include the injection of special dye, called contrast medium. With most MRI machines, the person lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some machines are designed to allow the person to lie in a more open space. An MRI can show signs of inflammation, a burst appendix, a blockage in the appendiceal lumen, and other sources of abdominal pain. An MRI used to diagnose appendicitis and other sources of abdominal pain is a safe, reliable alternative to a computerized tomography (CT) scan.²
CT scan. CT scans use a combination of x rays and computer technology to create three-dimensional (3-D) images. For a CT scan, the person may be given a solution to drink and an injection of contrast medium. CT scans require the person to lie on a table that slides into a tunnel-shaped device where the x rays are taken. The procedure is performed in an outpatient center or a hospital by an x-ray technician, and the images are interpreted by a radiologist; anesthesia is not needed. Children may be given a sedative to help them fall asleep for the test. A CT scan of the abdomen can show signs of inflammation, such as an enlarged appendix or an abscess—a pus-filled mass that results from the body’s attempt to keep an infection from spreading—and other sources of abdominal pain, such as a burst appendix and a blockage in the appendiceal lumen. Women of childbearing age should have a pregnancy test before undergoing a CT scan. The radiation used in CT scans can be harmful to a developing fetus.

²Heverhagen J, Pfestroff K, Heverhagen A, Klose K, Kessler K, Sitter H. Diagnostic accuracy of magnetic resonance imaging: a prospective evaluation of patients with suspected appendicitis (diamond). Journal of Magnetic Resonance Imaging. 2012;35:617–623.

How is appendicitis treated?

Appendicitis is typically treated with surgery to remove the appendix. The surgery is performed in a hospital; general anesthesia is needed. If appendicitis is suspected, especially in patients who have persistent abdominal pain and fever, or signs of a burst appendix and infection, a health care provider will often suggest surgery without conducting diagnostic testing. Prompt surgery decreases the chance that the appendix will burst.
Surgery to remove the appendix is called an appendectomy. A surgeon performs the surgery using one of the following methods:

Laparotomy. Laparotomy removes the appendix through a single incision in the lower right area of the abdomen.
Laparoscopic surgery. Laparoscopic surgery uses several smaller incisions and special surgical tools fed through the incisions to remove the appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time.

With adequate care, most people recover from appendicitis and do not need to make changes to diet, exercise, or lifestyle. Surgeons recommend limiting physical activity for the first 10 to 14 days after a laparotomy and for the first 3 to 5 days after laparoscopic surgery.

What are the complications and treatment of a burst appendix?

A burst appendix spreads infection throughout the abdomen—a potentially dangerous condition called peritonitis. A person with peritonitis may be extremely ill and have nausea, vomiting, fever, and severe abdominal tenderness. This condition requires immediate surgery through laparotomy to clean the abdominal cavity and remove the appendix. Without prompt treatment, peritonitis can cause death.
Sometimes an abscess forms around a burst appendix—called an appendiceal abscess. A surgeon may drain the pus from the abscess during surgery or, more commonly, before surgery. To drain an abscess, a tube is placed in the abscess through the abdominal wall. The drainage tube is left in place for about 2 weeks while antibiotics are given to treat infection. Six to 8 weeks later, when infection and inflammation are under control, surgeons operate to remove what remains of the burst appendix.

What if the surgeon finds a normal appendix?

Occasionally, a surgeon finds a normal appendix. In this case, many surgeons will remove it to eliminate the future possibility of appendicitis. Occasionally, surgeons find a different problem, which may also be corrected during surgery.

Can appendicitis be treated without surgery?

Nonsurgical treatment may be used if surgery is not available, a person is not well enough to undergo surgery, or the diagnosis is unclear. Nonsurgical treatment includes antibiotics to treat infection.

What should people do if they think they have appendicitis?

Appendicitis is a medical emergency that requires immediate care. People who think they have appendicitis should see a health care provider or go to the emergency room right away. Swift diagnosis and treatment reduce the chances the appendix will burst and improve recovery time.

Eating, Diet, and Nutrition

Researchers have not found that eating, diet, and nutrition play a role in causing or preventing appendicitis. If a health care provider prescribes nonsurgical treatment for a person with appendicitis, the person will be asked to follow a liquid or soft diet until the infection subsides. A soft diet is low in fiber and is easily digested in the GI tract. A soft diet includes foods such as milk, fruit juices, eggs, puddings, strained soups, rice, ground meats, fish, and mashed, boiled, or baked potatoes. People can talk with their health care provider to discuss dietary changes.