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 the McBurney’s point is a super important sign for identifying appendicitis, also along with the fever, other classic symptoms include nausea and vomiting. Now if that obstruction persists, the pressure in the appendix increases even more at a certain point as the pressure keeps going and it continues to swell up and it pushes 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 in keeping bacteria out…now the growing colony of bacteria can invade the wall of the appendix. As more cells die, the ependymal wall becomes weaker and weaker and for a small proportion of patients, it gets weaker to the point where the appendix ruptures, which is 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 the McBurney’s point. Patients might also have some abdominal guarding or the abdominal muscles tense up when pressed to try and avoid pain.

The most common complication with the ruptured appendix is pus and fluid getting out and forming an abscess around the appendix called the para appt indicial abscess sometimes subphrenic abscess might also form and these would be tiny abscesses below the diaphragm but above the liver or the spleen, the standard treatment for appendicitis is appendectomy which is a surgical removal of the appendix along with antibiotics. The 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.

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