Appendicitis and Stress: No Causal Link

Stress does not cause appendicitis. Appendicitis is inflammation of the vermiform appendix, typically due to luminal obstruction.

Actual Pathophysiology

1. Obstruction: Fecalith (calcified stool), lymphoid hyperplasia (viral), parasites, tumors, foreign bodies.
2. Bacterial Overgrowth: Stasis → proliferation (E. coli, Bacteroides) → inflammation.
3. Increased Intraluminal Pressure: Compromises venous → arterial flow → ischemia, necrosis, perforation.

Stress Effects (Real but Distinct)

• Can cause functional GI symptoms: abdominal pain, nausea, altered bowel habits (IBS).
• May exacerbate perception of pain.
• Does not cause appendiceal obstruction or inflammation.

Clinical Presentation

• Periumbilical pain → migrates to RLQ (McBurney's point)
• Anorexia, nausea, low-grade fever
• Rebound tenderness, guarding, Rovsing's sign, psoas/obturator signs
• Leukocytosis, elevated CRP

Treatment

Appendectomy (laparoscopic preferred) ± antibiotics. Uncomplicated cases may trial antibiotics alone (CODA trial), but surgery remains standard.

Stress management is important for overall health but does not prevent or cause appendicitis.