Appendicitis is a common disease in which the appendix becomes inflamed. This inflammation can affect anyone, but is particularly common in adolescents and young adults. Without timely treatment, appendicitis can cause serious complications such as a rupture of the appendix. In this article, we explain what appendicitis is, what symptoms it causes, how it is diagnosed and which laboratory values play a key role.

What is appendicitis?

The appendix is located in the right lower abdomen, where the small intestine merges into the large intestine. Its exact function is not fully understood, but it probably plays a role in the immune system. Appendicitis usually occurs when the appendix becomes blocked, for example by stool, foreign bodies or swelling of the lymph nodes. This blockage leads to a build-up of bacteria that trigger inflammation. In rare cases, infections or injuries can also be the cause.

Symptoms of appendicitis

The symptoms of appendicitis often develop quickly, within a few hours to days. Typically, the pain begins diffusely in the abdomen, often around the navel, and then shifts to the right lower abdomen. This pain usually becomes more severe, especially when coughing, walking or pressing on the area. Other common symptoms are

• Nausea and vomiting: Many sufferers feel sick and have to vomit.
• Loss of appetite: The desire to eat often disappears completely.
• Fever: A slight increase in temperature (around 38 °C) is typical, in more severe cases the fever may rise.
• Altered digestion: Some have diarrhea or constipation.

The symptoms can vary depending on age and course. They are often less clear in children or older people, which makes diagnosis more difficult.

Diagnosis of appendicitis

The diagnosis of appendicitis is based on a combination of physical examination, the symptoms described and diagnostic tests. Doctors typically check the so-called McBurney point (a point in the right lower abdomen), which is painful when pressure is applied. The Rovsing’s sign (pain in the right lower abdomen when the left lower abdomen is pressed) or the psoas sign (pain when the right leg is stretched) can also provide clues.

In addition to the physical examination, imaging procedures such as ultrasound or CT scans are important to visualize the inflammation. However, laboratory values also play a decisive role, as they provide information on the inflammation and its severity.

Important laboratory values for appendicitis

Laboratory tests help to confirm appendicitis and rule out other causes for the symptoms. The following laboratory values are particularly relevant:

1. Leukocytes (white blood cells):
   • Meaning: An elevated value indicates inflammation or infection.
   • Normal range: 4,000-10,000 per microliter.
   • In appendicitis: Frequently elevated (often 10,000-20,000). Very high values can indicate complications such as a rupture.
   • Special feature: The increase may be less pronounced in older people or children.
     
2. C-reactive protein (CRP):
   • Significance: CRP is a marker for acute inflammation in the body.
   • Normal range: Below 5 mg/l.
   • In appendicitis: Usually elevated, often between 10-50 mg/l. Highly elevated values indicate a more severe inflammation or complications.
   • Special feature: The value often rises with a delay, so it is particularly meaningful in the case of long-term complaints.
     
3. Neutrophil granulocytes:
   • Significance: This subgroup of white blood cells increases with bacterial infections.
   • Normal range: 50-70 % of the leukocytes.
   • In appendicitis: Frequently elevated (over 70 %), which indicates an acute bacterial inflammation.
   • Special feature: A so-called “left shift” (increased immature neutrophils) is typical for acute infections.
     
4. erythrocyte sedimentation rate (ESR):
   • Significance: Indicates general inflammatory processes, but is less specific.
   • Normal range: men <15 mm/h, women <20 mm/h.
   • For appendicitis: May be elevated, but is used less frequently as it is less accurate.
     
5. Urinalysis:
   • Significance: Is performed to rule out other causes such as urinary tract infections or kidney stones.
   • With appendicitis: Normally unremarkable. Slight abnormalities (e.g. some blood in the urine) can be caused by the proximity of the inflammation to the bladder.

Treatment and progression

The standard treatment for appendicitis is surgical removal of the appendix, known as an appendectomy. This is usually carried out using minimally invasive laparoscopy, whereby only small incisions are made. In some cases, e.g. mild inflammation, antibiotics can be used initially, but surgery is the gold standard to avoid complications.

Without treatment, the inflammation can lead to a rupture of the appendix, allowing bacteria to enter the abdominal cavity and trigger a dangerous inflammation of the peritoneum (peritonitis). Rapid diagnosis is therefore crucial.

Conclusion

Appendicitis is a serious but easily treatable condition that is characterized by typical symptoms such as pain in the lower right abdomen, fever and nausea. The diagnosis is supported by physical examinations, imaging and laboratory values. The leukocyte count, CRP and neutrophil granulocytes in particular provide important indications of the inflammation and its severity. Anyone who notices symptoms of appendicitis should consult a doctor quickly in order to avoid complications. Thanks to modern medicine, the prognosis is excellent with timely treatment.

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Gender note. The personal designations used in this text always refer equally to female, male and diverse persons. Double/triple references and gendered designations are avoided for the sake of better readability ected.