What is appendicitis?

Appendicitis refers to the painful swelling of the appendix, a small pouch-like tissue that extends from the large intestine. The condition causes pain that begins near the navel and shifts towards the lower right abdomen.

The appendix is otherwise a rudimentary organ in the body with no specific function.

In some cases, appendicitis may progress to an infection or pus-filled abscess outside he inflamed appendix. An abscessed appendix, however, the infected appendix gets walled off from the rest of the abdomen with the formation of scar tissue.

What are the causes of the disorder?

The cause of appendicitis is unclear but it may result from the following situations:

  1. Obstruction in the digestive tract – Food waste or hard faeces may get trapped in the appendix, causing its cavity to get blocked. Bacterial growth may lead to swelling and formation of pus.
  2. Infection – A gastrointestinal viral infection or an inflammatory bowel disease like the Crohn’s disease and ulcerative colitis may cause blockage in the appendix.

Both cases lead to inflammation of the appendix and formation of pus. Left untreated, it may result in the rupturing of the appendix.

What one needs to know about symptoms or signs?

The first signs of appendicitis are generally pain the middle of the abdomen that comes and goes. Within hours, the pain relocates to the lower right side of the abdomen and becomes more severe and constant.

Patients may feel the following signs:

  1. Pain upon pressing the appendix area, coughing or walking
  2. Tenderness when pressure is applied
  3. Vomiting and a feeling of sickness
  4. Loss of appetite
  5. Constipation
  6. Diarrhoea
  7. Fever

Which specialist should be consulted in case of signs and symptoms?

Persons who experience intense abdominal pain must consult a general practitioner who would determine if the cause of the pain is due to appendicitis, and have the person hospitalised immediately if appendicitis is determined.

What are the screening tests and investigations done to confirm or rule out the disorder?

The doctor will examine the person’s abdomen to check if the pain worsens upon applying pressure on the lower right side and ask other questions regarding the symptoms. Physical examination is generally sufficient to confirm appendicitis.

However, the following tests may be conducted:

  1. Blood test to check for infection
  2. Urine test to check for infection
  3. Imaging tests (ultrasound scan, magnetic resonance imaging (MRI) scan, abdominal x-ray, CT scan)

What treatment modalities are available for management of the disorder?

Appendicitis is treated through surgery by removing the inflamed appendix, also known as appendectomy. Two types of surgeries may be carried out depending on the patient’s situation:

Laparoscopic or keyhole surgery – Three small cuts are made to remove the appendix, which is done by inserting special tools and a tube with a fitted video camera. Scarring is minimal and recovery is fast.

Open surgery – Certain circumstances do not allow laparoscopic technique such as:

  1. A burst appendix
  2. Patients with tumour in the digestive system
  3. Pregnant women in first trimester
  4. Patients who have earlier undergone a stomach surgery

In such a case, the surgeon removes the appendix through a single, large abdominal incision. Both laparoscopic and open surgeries are performed under general anaesthesia.

In cases where an abscess formation has taken place, the surgeon will first drain it by placing a tube through the skin, and surgery is performed weeks after the infection is brought under control.

What are the known complications in management of the disorder?

An untreated appendicitis may burst and cause more threatening conditions:

  1. Peritonitis – Pus is released to other parts of the body that leads to infection in the abdomen. The condition refers to painful swelling of the abdomen in the stomach and liver.
  2. Abscess – An abscess is a painful condition in which pus collects around a burst appendix. It can be treated with antibiotics or draining of the pus through a surgical procedure.

What are the dietary and physical activity requirements during the course of the treatment?

The patient’s activity levels will be restricted in the first few weeks after the surgery. It may take between four to six weeks to regain normal activities. Recovering patients must not lift heavy weight or perform strenuous exercise in the initial weeks. Clear fluids will be allowed on the first day after surgery. Introduction to solid foods should be gradual to allow the bowel to heal properly.

How can the disorder be prevented from happening or recurring?

There is no known method to prevent appendicitis completely but the chances of acquiring it are less in people who eat foods like fruits and vegetables that are rich in fibre.

Sources: “Appendicitis,” MayoClinic.com, Mayo Clinic Staff, https://www.mayoclinic.com/health/appendicitis/DS00274 “Appendicitis,” MedlinePlus, NLM,NIH, https://www.nlm.nih.gov/medlineplus/ency/article/000256.htm “Appendicitis,” NHS.uk, https://www.nhs.uk/conditions/Appendicitis/Pages/Introduction.aspx “Appendicitis,” WebMD.com, https://www.webmd.com/digestive-disorders/digestive-diseases-appendicitis

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