Everything you need to know about appendicitis

Appendicitis is a disease in which the appendix gets swollen, inflamed and full of pus. The appendix on the right side of the abdomen is a narrow finger-shaped pouch, attached to the colon.

It’s not clear the exact position of the appendix. It may be a hosting region of friendly bacteria that aid digestion and fight infection.

It may also contribute to the immune system and affect the ability of the body to fight off the infection.

Appendicitis is likely due to the fact that either a stomach infection travels to the appendix or a hard piece of stool gets stuck in the appendix, causing infection.

Appendicitis can occur at any age, most typically from older children to adults in their 30s. This happens most often during the second decade of life. Each year more than 250,000 appendectomies (removal of the appendix) are carried out in the United States.

Fast facts on appendicitis

  • Scientists are still debating the function of the appendix.
  • Symptoms of appendicitis include a progressively worsening pain, nausea, and vomiting.
  • Often, surgery is the best course of action.
  • More than a quarter of a million Americans have an appendectomy each year.

Signs and symptoms

A man having pain in the abdomen
Anyone who experiences a progressively worsening pain in the abdomen should seek medical attention.

Appendicitis is often a first symptom of discomfort across the abdominal area.

As the infection progresses, the position of the pain in the lower right side of the abdomen, an area known as the McBurney point, becomes more defined.

The most common symptoms are:

  • progressively worsening pain
  • painful coughing or sneezing
  • nausea
  • vomiting
  • diarrhea
  • inability to pass gas (break wind)
  • fever
  • constipation
  • loss of appetite

Anyone suffering a rapidly worsening abdominal pain should be seeking medical attention. Many disorders, such as a urinary tract infection, may have similar symptoms. Even so, all need urgent medical attention.

Diagnosis

Around half of all appendicitis patients have no typical symptoms and this can make diagnosis difficult. For instance, the pain is not always in the lower right quadrant of the abdomen.

Additionally, other conditions may have similar symptoms, such as:

  • gastroenteritis
  • urinary tract infection
  • ectopic pregnancy
  • Crohn’s disease
  • kidney stones

Not all appendices are in the same position. Sometimes it is found in the back of the intestine, the liver or the pelvis.

A doctor will examine the patient, as well as ask questions about their symptoms. They can exert pressure on the area to see if the pain gets worse.

If the doctor detects usual signs and symptoms, then appendicitis is diagnosed. If not, they will order further checks.

Tests may include:

  • blood tests, to check for infection
  • an MRI, CT, or ultrasound scan, to see if the appendix is inflamed
  • urine tests, to identify a kidney or bladder infection

Researchers at the Children’s Hospital’s Proteomics Center in Boston, MA, have shown that a protein detected in urine can be useful as a biomarker for appendicitis.

Often, a doctor may want to remove the appendix surgically because waiting for tests to confirm the diagnosis is too dangerous.

Surgery

If the infection is mild, antibiotics are sometimes used to treat appendicitis, but this is rare.

In most cases, a surgeon will remove the appendix. Often, this is done through keyhole surgery, or laparoscopy.

Laparoscopy

Surgical removal of the appendix is known as an appendectomy.
Surgical removal of the appendix is known as an appendectomy.

Laparoscopic, keyhole, or minimally invasive surgery (MIS) involves the following steps:

  • The surgeon inserts a very thin tube, or laparoscope, which has a tiny video camera and light, into the abdomen, through a hollow instrument known as a cannula.
  • The surgeon can view the inside of the abdomen, magnified, on a monitor.
  • Tiny instruments respond to the movements of the surgeon’s hands, and the appendix is removed through small abdominal incisions.

This is a precise procedure, with minimal blood loss and a minor incision. As a result, recovery time is shorter than with open surgery, and less scarring occurs.

Open surgery

A bigger incision will be made in some cases, so that the area inside the abdominal cavity can be cleaned.

This will happen if:

  • the appendix has ruptured, and infection has spread
  • the appendix has caused an abscess
  • the patient has tumors in the digestive system
  • the patient is a woman in her third trimester of pregnancy
  • the patient has had many abdominal surgeries before

The patient will be administered antibiotics intravenously after the procedure.

Delaying surgery

When symptoms have lasted at least 5 days, a course of antibiotics may be prescribed by your doctor to compress the appendix and clear up the surrounding infection. They will later undergo surgery.

If an abscess occurs, it may be drained first by the doctor, and operated later.

Antibiotics

Some scientists believe that antibiotics may be a safe and effective alternative for acute, uncomplicated appendicitis.

Others disagree. A study published in the Lancet argues that surgery for appendicitis is more effective.

Recovery time

The patient normally will go home after 24 hours in the case of keyhole surgery. There may be some constipation for the first few days, and some pain and swelling. There I also have pain at the shoulder tip as a result of gas being pumped into the abdomen during the process.

Over- the-counter (OTC) pain relievers can be of help with discomfort.

If open surgery is needed, or if the person has peritonitis or some other infection, they may have to stay in the hospital for up to a week.

Returning to regular activities normally takes around 2 weeks, but the patient may need to wait 4 to 6 weeks to do more strenuous activity.

The physician must advise on how much activity is necessary at each time.

It is best to contact your doctor if there are signs of infection.

These include:

  • worsening pain and swelling
  • repeated vomiting
  • high temperature
  • the site of the operation is hot to touch, or there is pus or other discharge

Prevention

Countries with lower appendicitis incidences often appear to have more fibre in their diets.

A high-fiber diet can help to decrease the chances of developing appendicitis by making softer stools is less likely to get stuck in the appendix.

Complications

The following are possible complications caused by appendicitis.

Peritonitis

If the appendix breaks and releases the infection into the abdomen, the patient may develop peritonitis which is a peritoneum infection and inflammation. The peritoneum is the membrane that forms the cavity of the abdomen and protects most abdominal organs.

Peritonitis can cause the bowels to stop bowel movements, and obstruct the intestine. The patient is going to develop a fever, and may be in shock. Peritonitis is in serious need of care.

Abscess

If the infection falls out of the appendix and mixes with the contents of the intestines, an abscess can form. This can cause peritonitis if the abscess is not treated. The abscesses are sometimes treated with antibiotics. They are often drained surgically with the aid of a tube that is inserted inside the abdomen.

Appendictis can be life-threatening complications. It is important that anyone who has appendicitis will seek medical help.

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