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Appendicitis
September 20 , 2013

The Appendix

The appendix is a 3 1/2-inch-long tube of tissue that extends from the large intestine. It is a finger-shaped pouch that projects out from the colon on the lower right side of the abdomen. Its function is not really certain, and an individual can live without it without apparent consequences.

Appendicitis

This is a condition in which the appendix becomes inflamed and fills with pus. It is a medical emergency that requires prompt surgery to remove the appendix. Appendicitis can affect anyone.  In the U.S., one in 15 people will get appendicitis. Although it can strike at any age, appendicitis is rare under age 2 and most common between ages 10 and 30. Untreated, mortality is high, mainly because of the risk of rupture leading to infection and inflammation of the intestinal lining and eventual sepsis, clinically known as peritonitis which can lead to circulatory shock. Appendicitis causes pain that typically begins around your navel and then shifts to your lower right abdomen. Appendicitis pain typically increases over a period of 12 to 18 hours and eventually becomes very severe. A non-acute form of appendicitis is known as rumbling appendicitis. Sometimes a pus-filled abscess forms outside the inflamed appendix. Scar tissue then "walls off" the appendix from the rest of the abdomen, preventing infection from spreading. An abscessed appendix is a less urgent situation, but unfortunately, it can’t be identified without surgery. For this reason, all cases of appendicitis are treated as emergencies, requiring surgery.

 

Causes of appendicitis.

The cause of appendicitis isn’t always apparent. It may occur due to:

- Infection: Appendicitis may follow an infection, since the appendix swells in response to any infection in the body, such as a gastrointestinal viral infection, or it may result from other types of inflammation. The bacteria inside the appendix multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture. 

-  Calcified fecal deposits known as appendicoliths or fecaliths: The occurrence of obstructing fecaliths has attracted attention since their presence in patients with appendicitis is significantly higher in developed than in developing countries, and an appendiceal fecalith is commonly associated with complicated appendicitis.

-cancer

-intestinal worms

-lymphadenitis

-trauma

Signs and Symptoms

- Dull pain that begins around the navel and becomes sharper as it moves to the lower right abdomen. However, the location of the pain may vary, depending on age and the position of the appendix. Young children or pregnant women, especially, may have appendicitis pain in different places.

- Pain that become sharper over several hours

- Abdominal swelling

- Pain that worsens if you cough, walk or make other jarring movements

- Nausea

- Vomiting

- Loss of appetite

- Fever

- Constipation

- Diarrhea

- Severe cramps

Diagnosis

This is based on patient symptoms and physical examination backed by an elevation of neutrophilic white blood cells. Typical appendicitis usually includes abdominal pain beginning in the region of the umbilicus for several hours, associated with anorexia, nausea or vomiting. The combination of pain, anorexia, leukocytosis, and fever is classic. Atypical appendicitis lacks this typical progression and may include pain in the right lower quadrant as an initial symptom. Atypical histories often require imaging with ultrasound and CT scanning. 

Management

Acute appendicitis is typically managed by surgery however in uncomplicated cases antibiotics are both effective and safe. While antibiotics are effective for treating uncomplicated appendicitis 20% of people had a recurrence within a year and required eventual appendectomy. Pain medications such as morphine are also given. However, antacids, laxatives, or heating pads, which can cause an inflamed appendix to rupture shouldn’t be taken.

. . . . .

Learn more about this author, Victory Oyaletor.
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