What Is Appendicitis?
Appendicitis is an inflammation of the appendix, which is a small tube of intestinal tissue that projects from the large intestine. While the appendix does not seem to have a particular function, one theory suggests that it acts as a storehouse of good bacteria and boosts immunity after diarrheal illness. However, some experts believe the appendix is just a purposeless remnant from our evolutionary past. One thing we’re sure of is that we can live without it, without any apparent consequences.
Appendicitis is a common cause of acute abdominal pain. About 5% of the American population develops appendicitis at some point in their life. In 2015, about 11.6 million cases of appendicitis occurred, out of which 50,100 resulted in death.
Pain usually commences in the peri-umbilical region (the area around the navel) and gradually moves to the lower right corner of the abdomen. Severe pain requires prompt surgical removal of the appendix. Left untreated, it may lead to thrombosis (clotting of blood) in the appendicular artery, which results in gangrene and eventually, rupture of the appendix.
Causes Of Appendicitis
Although it can strike at any age, appendicitis is most likely to occur between the ages of 10 and 30. It is more common in males than females. In young people, appendicitis is usually caused by enlargement of the lymphatic follicles present inside the appendix that lead to blockage of its lumen. Whereas in older people, the main cause of the blockage is a fecalith (a hard mass of feces). Tumors may also cause the blockage. The appendix then becomes inflamed and produces secretions. These secretions, when unable to escape, cause the appendix to swell and irritate the adjoining abdominal wall. The end result is a burst appendix, releasing bacteria into the abdominal cavity and causing further complications.
Signs and symptoms of appendicitis
Common symptoms include abdominal pain, vomiting, Nausea and lack of appetite. However, about 40% people do no show these classical symptoms. Appendicitis can be detected before rupture if given timely medical attention. If you or someone in your care develops the following signs, go to a physician immediately.
The site of pain may vary according to age and position of the appendix. In pregnant women, it may seem to come from the upper abdomen. The pain may not necessarily begin in the standard lower right region; it may begin in the navel area and move to the right side over a period of a few hours to a few days. Appendicitis pain can be the worst abdominal pain of your life. Whether or not it’s appendicitis, it is essential that you seek medical attention.
Lack of appetite and nausea
Not everyone suffering from appendicitis experiences lack of appetite, but abdominal pain while feeling nauseous and vomiting necessitates a visit to the emergency room.
Foggy thinking, confusion, and fatigue
Appendicitis can affect the nervous system which may lead to lack of focus and poor cognitive abilities. Dr. Gingold explains the brain fog effect: “It’s not that anything is going on in the brain – just that the infection is getting worse and expending a lot of body resources including oxygen, so the brain doesn’t get enough and doesn’t work normally.”
Chills and fever
The presence of chills and fever indicates that there is inflammation somewhere in the body. Chills and fevers while experiencing abdominal pains and nausea may point towards appendicitis.
Frequent urination and pain while urinating
For 32% of the people, the appendix is in the pelvic position i.e. in the lower abdomen right next to the bladder. An inflamed appendix can irritate or inflame the bladder, resulting in not only frequent need to urinate but also pain while urinating.
Other symptoms include abdominal bloating, constipation or diarrhea, and worsening of pain upon coughing, walking or other jarring movements.
The most common complication of appendicitis is ruptured appendix which occurs in cases not diagnosed timely. The infection can spread to the entire lining of the abdominal wall, causing widespread inflammation.
Types Of Appendicitis
Appendicitis is generally classified into two main types based on the period of development of your symptoms:
Acute And Chronic
Acute appendicitis is more common, develops over a few days or less and shows classical symptoms of the disease making diagnosis easier.
Chronic appendicitis accounts for 1 to 2% of all cases of appendicitis, develops slowly and requires ongoing treatment for inflammation.
Diagnosis And Treatment
After the primary symptom, which in pain, the other symptoms manifest within 24 hours. The time it takes for the blockage to form until the appendix bursts are only 72 hours, and sometimes less. Therefore you must see a doctor and diagnosis and treatment must be done within this time period to prevent further complications.
Diagnosis is based on a history of signs and symptoms, and physical examination. The symptoms may be vague, or similar to other diseases such as Crohn’s disease, gastritis, urinary tract infection, intestinal infection and ovary problems.
Tests and procedures used for diagnosis of appendicitis include:
Physical abdominal examination
The physician may apply light pressure to the stomach to detect inflammation. A sudden release of pressure causes sudden sharp pain. This is known as ‘rebound tenderness’. Increased pain on palpating a specific area on the lower right abdomen called the Petit triangle is known as Aure-Rozanova’s sign. Whereas increased pain in the lower right abdomen while coughing is known as Dunphy’s sign.
A blood test is done to examine the levels of white blood cells, primarily the neutrophils, in the blood. About 70 to 90% of the people with appendicitis show an elevated white blood cell count due to infection.
Your physician may want you to have a urine test in order to rule out urinary tract infection or kidney stones that may be causing the pain.
Ultrasound or CT scan
Your physician may also want you to have an ultrasound or a CT scan to confirm appendicitis or to rule other other causes of pain.
Magnetic Resonance Imaging (MRI)
Use of MRI for diagnosis of appendicitis has become increasingly common for children and pregnant women because of its lesser health risks as compared to radiation.
Treatment usually involves surgical removal (appendectomy) of the inflamed appendix. A dose of antibiotics may be given before surgery to fight infection of the abdominal cavity. Appendectomy is performed as an open surgery using a 5 to 10 cm long abdominal incision. Surgery usually takes about 30 minutes to an hour and 2 to 3 days stay at the hospital. Full recovery occurs within 2 to 3 weeks.
After an appendectomy, call your doctor if you have:
- Dizziness, fainting
- Blood in your urine or vomit
- Increased pain in the incision
- Pus in the wound
An alternate and more advanced procedure is laparoscopy which is done through a few small incisions. During a laparoscopic appendectomy, the surgeon inserts surgical tools and a camera into your abdomen to remove your appendix. If the appendix has already ruptured and the infection has spread, you may need an open appendectomy so that the abdominal cavity can be cleaned.
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