Definition and Overview

Appendicitis is a condition characterised by the inflammation of the appendix, a small pouch connected to the large intestine. Depending on the type of appendicitis, the condition may require an emergency surgery.

The appendix, though small, has been a subject of contention among health experts as they try to understand what its real role is. A 2012 study mentioned that it may serve as a protection for the good bacteria that keep the gut healthy. Nevertheless, removing the organ partially or completely does not affect the digestive process.

There are three different types of appendicitis:

  • Acute – If the appendicitis happens suddenly, it is referred to as acute. Most of the cases fall under this category and require immediate surgery. Otherwise, the appendix can rupture and cause perforation, wherein toxins spread to the abdomen. The condition then becomes life-threatening.

  • Chronic – Sometimes, appendicitis can be chronic, which means the inflammation can occur and disappear multiple times in days or even years. This normally happens when the obstruction is only partial or some factors, such as pressure in the pouch, remove a part of the obstruction. Although this does not require immediate attention, the condition can worsen, which will eventually require surgery.

  • Stump – Stump appendicitis occurs when a portion of the appendix remains and becomes inflamed.

Causes of the Condition

The definite cause of appendicitis is a blockage from a variety of objects including fecal matter. It may also be caused by bacteria, parasites, and in rare cases, a tumour.

The appendix has an opening located in the middle of the large or small intestine. It also has a lining that has the ability to secrete certain substances. However, the other end is closed, which means that anything that gets into the appendix cannot be eliminated unless there’s a pressure inside it that pushes what is lodged out of the pouch.

When the object is not removed or the appendix continues to be blocked, the lining becomes more aggressive in its secretions, triggering the swelling. As the appendix swells and as the supply of blood to the organ diminishes, the tissue becomes necrotic or begins to die. Appendicitis Symptoms Some of the common signs of appendicitis are:

  • Bad breath

  • Difficulty in passing gas

  • Feeling of bloating

  • Fever

  • Loss of appetite

  • Nausea and vomiting

  • Pain during urination

  • Pain in the rectum, lower back, or any part of the abdomen

  • Severe cramps

  • Appendicitis pain

  • Swelling of the abdomen

In some cases, the symptoms of appendicitis can be very mild. The condition may also be difficult to diagnose immediately since it has a mesentery, a thin membrane that connects the appendix to nearby organs. If it’s pronounced, then it’s hard to clearly pinpoint where the pain is really coming from.

But one of the distinct signs of appendix inflammation is appendix pain. Appendix pain location usually begins either around the navel or the upper section of the abdomen. The pain may worsen and last for several hours; sort of traveling from its point of origin toward the lower right side of the abdomen – the appendix location.

Who to See and Treatments Available

Unfortunately, there is no standard test to diagnose a patient with inflamed appendix symptoms. Moreover, the exams that are performed are often standard that it is possible that appendicitis can be diagnosed as something else.

One of the tests that should be carried out if a patient suffers from the symptoms of appendix inflammation is physical examination. The family medicine doctor (for children) or internist (for adults) will press the abdominal area especially around the navel if appendicitis is suspected. If there is inflammation, the site should be tender, which can range from moderate to severe. Sometimes the pain can worsen after the area has been pressed.

Physical examination may then be followed by other tests, such as:

  • CBC – CBC, or complete blood count, reveals how many red and white blood cells a patient has. If there’s an infection, which is usually the direct result of an inflammation, the white blood cells are typically elevated. This may also explain the fever.

  • Ultrasound – A whole abdomen ultrasound is one of the tests that can be performed if the doctor wants to rule out other diseases affecting other organs close to the appendix such as the ovaries and the fallopian tubes.

  • Urinalysis – Since the appendix is close to the bladder and ureter, signs of infection may also be detected in the urine. This can also be performed to rule out other infections.

If appendicitis is confirmed, surgery is almost always recommended to avoid serious, life-threatening complications.

In many cases, appendicitis is considered an emergency. If the patient has appendicitis but the appendix has not yet burst, a keyhole surgery, also referred to as laparoscopy, may be carried out. In this procedure, the patient is placed under anaesthesia for maximum comfort. Small incisions are then made in the abdomen, after which a laparoscope, a probe that has a small camera attached, is inserted. The scope then sends real-time images of the abdomen and the appendix, giving a precise idea of the condition. Very small surgical tools are then used to remove the part. The incisions are then closed using absorbable sutures.

Because the incisions are only small, the recovery period is fast.

On the other hand, if the appendix has already ruptured, it is wise to perform an open surgery to assess the extent of the damage. This calls for a larger incision in the lower-right portion of the abdomen after general anaesthesia is administered.

The patient is provided with painkillers to help deal with the bruising and pain that come within the first few days after the surgery.

Appendicitis may not be an emergency when a lump develops as a consequence of the immune system fighting the infection. The patient may be provided with medications before surgery is executed a few weeks after.

References:

  • Ben-David K, Sarosi GA Jr. Appendicitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 116.

  • Krajewski S, Brown J, Phang PT, Raval M, Brown CJ. Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis. Can J Surg. 2011;54:43-53. PMID: 21251432 www.ncbi.nlm.nih.gov/pubmed/21254132.

  • Kulik DM, Uleryk EM, Maguire JL. Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain. J Clin Epidemiol. 2013 Jan;66(1):95-104. PMID: 23177898 www.ncbi.nlm.nih.gov/pubmed/23177898.

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