Appendicitis

In this blog, you will get an insight into the causes & symptoms of Appendicitis. Also, learn about the best Appendicitis treatment in India.

Overview

The appendicitis is an inflammation of the appendix. An appendix is a small, worm-shaped pouch present at the beginning of the large intestine. It is usually 5 to 10 cm long. The function of the appendix is unknown but some scientists say that it acts as a storehouse for good bacteria. Others believe that it is a useless remnant from human evolution. The position of the appendix varies between individuals.

Appendicitis is a medical emergency that requires immediate attention. It is also the most common cause of abdominal surgery. Appendicitis can occur at any age and equally affects both men and women. However, it is slightly more prevalent in men who are 15 to 25 years old. Recent studies have shown a reduction of the number of cases of appendicitis in western countries. The incidence in Asian and African countries may be lower. But actual figures from these countries are not available. The prevalence of appendicitis is low in cultures where a high-fiber diet is consumed regularly.

Appendicitis occurs when a blockage of the appendix causes it to be infected and inflamed. The appendix becomes swollen, infected and painful in this situation. The inflammation can also spread to the body structures surrounding the appendix.

The resulting pain and symptoms can mimic other conditions like urinary tract infection or stomach ulcer. However, appendicitis is an emergency condition that requires immediate treatment. Diagnosis of appendicitis relies heavily on the experience of the doctor. The diagnosis is made from the physical signs of the patient and investigations. Pain in the right lower region of the abdomen is the most common symptom associated with appendicitis. Investigations like ultrasound and laboratory tests are carried out for further evaluation and for clear observation of appendicitis. Treatment of appendicitis involves medications to control the infection and removal of the appendix by surgery. Surgical removal of the appendix is called an appendectomy. If appendicitis treatment is delayed, then the patient may develop complications like perforation, abscess and peritonitis.

Causes

• The exact reason why some individuals develop appendicitis is actually unknown. Several factors like blockage of appendix, infections, diet and family history are known to contribute.
• Appendicitis usually results from an obstruction of the appendix by fecal mass, stricture (narrowing), foreign objects, and worms, enlargement of lymphoid tissue, infections, injuries, and tumors.
• The presence of fecal mass, foreign body or viral infection causes swelling and irritation in the appendix. The blockage in the appendix causes increased the mucus production which exerts greater pressure on the walls of the appendix. The high pressure on the luminal wall of the appendix causes thrombosis (formation of a blood clot) of the small blood vessels.
• The inner lining of the appendix normally contains several lymphoid tissues. These are collections of immune cells called as lymphocytes. These lymphoid tissues can become enlarged in diseases of the intestine like inflammatory bowel disease, measles, amoebiasis and viral infections. This can also cause blockage of the appendix.
• Parasites like threadworms and flukes can also cause blockage of the appendix. Blockage of the appendix has also been shown in injuries like shotgun wounds to the abdomen and by a misplaced intrauterine contraceptive device like CuT. Infections like tuberculosis and cancers can also result in appendicitis.
• The increasing pressure reduces blood flow to the tissue. Adequate blood supply is required for the cells to remain healthy. Lack of blood supply causes cell death and necrosis of the appendix. When this happens, bacteria can multiply within the tube of the blocked appendix. As the bacteria multiply, immune and inflammatory cells like white blood cells (WBC) accumulate at the site of the infection and the whole process results in inflammation.
• The inflammation can cause the appendix to swell and become painful. It can also spread to the tissue and structures immediately surrounding the appendix and cause infection, thrombosis, and necrosis.
• If left untreated, the infected or inflamed appendix will burst (perforate) spilling the infectious material into the abdominal cavity and result in peritonitis. Sometimes a pus-filled abscess (a pocket of pus built up in the tissues) is formed outside the inflamed appendix. Due to these complications, appendicitis is an emergency condition requiring immediate surgical removal of the appendix.

Symptoms

Appendicitis symptoms form a classic triad of stomach pain, vomiting, and fever. But this typical presentation may not be presented in all cases.

Abdominal pain is the most common symptom of appendicitis. Typically, the pain starts in the middle of the abdomen and later shifts to the lower right side, where the appendix is usually located. The pain may worsen if the area where the appendix is located is pressed or while coughing or walking. In acute appendicitis, the affected individual experiences excruciating pain that causes him to bend his body by folding his legs to the chest.

The anatomic position of the appendix varies considerably between individuals. The location of the pain associated with appendicitis and the associated symptoms can also vary accordingly. An inflamed appendix near the urinary bladder may irritate the bladder and cause painful urination. If the appendix extends behind, inflammation can irritate the nerves and muscles behind and cause difficulty in walking.

Others symptoms of appendicitis are

• Fever
• Nausea and vomiting
• Loss of appetite
• Pain around the navel
• Bloating
• Frequent and painful urination

Appendicitis symptoms vary among different individuals and according to the duration of the inflammation. Depending on the duration of symptoms and the presence of complications appendicitis may be classified as acute, chronic, recurrent or complicated appendicitis.

Acute appendicitis

Acute appendicitis occurs when symptoms appear suddenly and with severe intensity. It lasts for 24 to 48 hours. This is the most common reasons for abdominal surgery in appendicitis.

Chronic appendicitis

It occurs when the inflammation of the appendix remains undiagnosed and the symptoms last for up to 3 weeks. The symptoms may appear and disappear. Usually, chronic appendicitis is diagnosed when the intensity of pain increases and the patient presents like acute appendicitis.

Recurrent Appendicitis

It is diagnosed when a patient has multiple episodes of lower abdominal pain due to appendicitis.

Complicated appendicitis

If left untreated, the infected or inflamed appendix will either burst or perforate spilling the infectious material in the abdominal cavity. Complicated appendicitis occurs when an appendix bursts due to increased pressure within it or when the appendix loses all its blood supply and becomes gangrenous. An appendicular abscess is formed when pus collects within a sac in the region near the appendix.

An appendix with abscess can also perforate or explode. The infectious material can spread within the abdominal cavity and cause peritonitis (inflammation inner wall of the abdomen).

The symptoms of appendicitis may be mimicked by a few conditions. These include

• Infections of the uterus and the surrounding structures
• Stones in the urinary tract
• Urinary tract infections
• Endometriosis
• Infection of the intestines
• Gallbladder stone and infection

Risk Factors

• Age: The risk of appendicitis is more in adolescents and young adults (15 to 25 years).
• Gender: Male has a greater risk than female
• Infection: Gastrointestinal infection increases the risk of appendicitis
• Trauma: Internal injury to appendix increased the risk of appendicitis
• Low fiber diet: A low fiber diet causes constipation and causes some of the fecal matter to become lodged in the appendix leading to appendicitis.

Diagnosis

Appendicitis is diagnosed by a doctor by taking a patient’s history, physical examination and by conducting investigations.

Physical examination

During the physical examination, the doctor checks the vital signs such as blood pressure, body temperature, rate of respiration and heartbeat. The doctor would also conduct a detailed examination of the abdomen and locate the site of pain. Patients with appendicitis have a fever, increased heart rate, pain in the right lower abdomen, and reduced movement of the intestines.

Laboratory test

• Blood test: The blood is tested to determine the white blood cell (WBC), count. Increase in WBC count is a common indication of infection.
• Other laboratory tests may be required to eliminate diseases of abdominal organs like liver and kidney or detect complications. These tests include
• CRP or C-reactive protein is elevated in complicated appendicitis
• The urine test is performed to detect urinary tract infections and kidney stones. These can also mimic symptoms of appendicitis. Pus cells can appear in the urine in some cases of appendicitis.
• Liver function tests
• Amylase test to detect diseases of the pancreas which can imitate appendicitis
• A pregnancy test is recommended in women because the symptoms of appendicitis can be imitated by an ectopic pregnancy.

Imaging test

• Abdominal ultrasound: The ultrasound is the initial investigation of choice in patients suspected with appendicitis. A sociologist uses an ultrasound machine to view the appendix and presence of complications.
• CT Scan: A CT scan is more sensitive than an ultrasound. It can detect appendicitis in patients who present will atypical symptoms and whom the appendix is located behind the large intestine
• X-ray (barium enema): It helps the doctor to examine the patient’s rectum, large intestine and the lower part of the small intestine. A fluid called barium is given to the patient in the form of a rectal enema. Then an X-ray of the abdomen is performed to examine the abdomen, obstruction in the appendix and to detect non -filling appendix. This test is not widely performed now.

Treatment

Medications

Medications are prescribed to patients with mild appendicitis. Some of the medications, which your doctor may prescribe you if you have mild appendicitis, are:

• Antibiotics: To reduce the bacterial infection
• Pain killers: To reduce the severity of pain

Surgery

Appendicitis treatment primarily consists of surgical removal of the appendix (appendectomy). The surgeon will remove the appendix by using one of the two methods: open or laparoscopic surgery.

a) Open appendectomy

During an open appendectomy, a single incision is made in the lower right area of the abdomen to remove the appendix. However, this technique has been widely replaced by laparoscopic surgery.

b) Laparoscopic appendectomy

Laparoscopic surgery requires smaller incisions and is less invasive. The surgeon makes three small incisions (each 1/4 – 1/2 inch) and inserts a laparoscope (a tiny telescope connected to a video camera) through a cannula into one of the incision. It helps the surgeon to have a magnified view the internal organs on a television monitor. Several other cannulas are inserted through the other incisions and the appendix is removed. Laparoscopic surgery nvolves smaller incisions and the recovery period is shorter.

Pain medications and antibiotics may be prescribed after the surgery.

Advantages of laparoscopic appendectomy

• Shorter hospital stay
• Decreased incidence of wound infection
• Smaller scars
• Complications of appendectomy:
• Bleeding
• Wound infection
• Injury to organs close to appendix

What a patient has to do before undergoing appendectomy?

If a patient is scheduled for an appendectomy, he or she has to follow these suggestions to prevent complications:

• Avoid eating or drinking anything 8 hours before the surgery.
• Give complete information about your past health to the surgeon.
• Inform the surgeon if you have the sensitivity to any medication or latex.
• Inform the surgeon about all the medications and supplements that you are taking.
• Inform the surgeon, if you are taking aspirin or anticoagulant medications, as they affect blood clotting. The surgeon may ask you to stop taking the medication before the surgery.

What should the patient do after discharge?

• The patient should take proper care after being discharged from the hospital. It helps to prevent infections and helps in early recovery.
• Avoid tiring activity.
• Keep the incision clean and dry.
• Take adequate rest until the doctor advises the patient to return to work and to normal activities.
• Consult the doctor immediately if the patient has fever, vomiting, pain, and redness at the site of incision or any other symptoms.

Prevention

• High-fiber diet: Including food rich in fiber such as sweet potatoes, flax seeds, raw almonds, mushrooms and so on will help to prevent appendicitis. Diet rich in fiber content helps prevent the obstruction of the appendix by fecal matter.
• Immediate medical care: In case of symptoms which may suggest appendicitis, approaching a doctor and following medical advice can prevent complications of appendicitis from developing.
• Dietary fiber is said to reduce the blockage of the appendix by fecal matter.

FAQs

• What are the long-term consequences of an appendectomy?

No long-term complications are associated with an appendectomy. You can resume your work 2 to 6 weeks after the surgery. However, it is important to follow a healthy lifestyle for good health.

• Is surgery the only method to treat appendicitis?

No. Mild appendicitis can be treated with antibiotics and painkillers. However, patients with severe appendicitis need surgical removal of the appendix to prevent further complications and infections.

• Which doctor should I consult for appendicitis?

You should consult a physician, a general surgeon, or a gastroenterologist for appendicitis.

• Can appendicitis occur during pregnancy? If yes, what is the treatment?

Appendicitis may happen around the second or third trimester of pregnancy. It may cause a fetal loss due to exposure to infectious fluids. The diagnosis and treatment remain the same for a pregnant patient and any other patient. However, additional care will be required. The surgeon, general physician, and gynecologist will closely monitor the patient.

• Which conditions can cause similar symptoms as that of Appendicitis?

Meckel’s diverticulitis, pelvic inflammatory disease (PID), inflammatory diseases of the right upper abdomen, right-sided diverticulitis, kidney diseases, and ectopic pregnancy are some of the conditions that mimic the symptoms of appendicitis.

Apollo Hospitals has the best appendicitis treatment doctors in India. To find out the best appendicitis doctors in your nearby city, visit the links below:

Appendicitis doctors in Bangalore

Appendicitis doctors in Chennai

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