Appendicitis

Causes of Appendicitis:

The exact cause of appendicitis is often unclear, but it is generally triggered when the appendix becomes blocked, leading to infection. Common causes of blockage include:

1. Fecal matter (fecaliths): Hard stool can obstruct the opening of the appendix.
2. Enlarged lymphoid follicles: These immune system structures can become inflamed during infections and block the appendix.
3. Infection: Viral, bacterial, or gastrointestinal infections may inflame the appendix.
4. Foreign bodies: Rarely, foreign objects or tumors can block the appendix.
5. Trauma: Injury to the abdomen may trigger appendicitis in some cases.

Symptoms of Appendicitis:

Appendicitis typically presents with a combination of the following symptoms:

• Abdominal pain: This is the hallmark symptom, beginning near the belly button and gradually shifting to the lower right side of the abdomen (McBurney’s point). The pain worsens with movement, coughing, or pressure.
• Loss of appetite: A sudden loss of appetite is common.
• Nausea and vomiting: These often follow the onset of abdominal pain.
• Fever: A low-grade fever may be present, which can become more severe if the appendix ruptures.
• Constipation or diarrhea: Some people may experience difficulty passing stool or loose stools.
• Abdominal bloating: Swelling or a sense of fullness in the abdomen may occur.
• Inability to pass gas: This may indicate a bowel obstruction or an inflamed appendix.

Diagnosis of Appendicitis:

1. Physical Examination:

   • Tenderness: Pressing on the lower right side of the abdomen may reveal tenderness or guarding (tensing of abdominal muscles).
   • Rebound tenderness: Pain upon release of pressure after pressing the abdomen may indicate peritoneal irritation.
   • Rovsing’s sign: Pain in the right lower abdomen when pressing on the left side may be a sign of appendicitis.
   • Psoas sign: Pain when lifting the right leg may indicate irritation of the appendix.

2. Laboratory Tests:

   • Blood tests: Elevated white blood cell counts suggest infection or inflammation.
   • Urine tests: Rule out urinary tract infections or kidney stones that may mimic appendicitis.

3. Imaging Tests:

   • Ultrasound: Commonly used, especially in children and pregnant women, to visualize the inflamed appendix.
   • CT scan: The most accurate imaging test for diagnosing appendicitis. It provides detailed images of the appendix and surrounding tissues.
   • MRI: Sometimes used in pregnant women or people who cannot have radiation exposure.

Treatment of Appendicitis:

1. Appendectomy:

   • Laparoscopic appendectomy: A minimally invasive surgery where small incisions are made to remove the appendix using a camera and instruments. This method has a shorter recovery time and less postoperative pain.
   • Open appendectomy: A larger incision is made in the lower right abdomen to remove the appendix. This method is used if the appendix has ruptured or if there are complications like abscesses.

2. Antibiotics:

   • Antibiotics are administered before and sometimes after surgery to treat or prevent infection.
   • In certain cases, where surgery may be risky, antibiotics alone may be used to treat mild appendicitis, but surgery is often recommended to prevent recurrence.

3. Drainage of Abscess:

   • If the appendix has ruptured and an abscess (a collection of pus) has formed, the abscess may need to be drained first before performing surgery. This can be done through a tube placed into the abdomen under imaging guidance.

Complications of Appendicitis:

1. Ruptured appendix: If left untreated, the appendix can burst, leading to the spread of infection into the abdomen (peritonitis). This is a life-threatening condition requiring emergency surgery.
2. Abscess: If the infection is contained, a pocket of pus (abscess) may form, which requires drainage.
3. Sepsis: A serious, body-wide infection can occur if the infection spreads into the bloodstream after the appendix ruptures.
4. Bowel obstruction: Inflammation or infection from a ruptured appendix can cause blockage in the intestines.

Recovery after Appendectomy:

• Hospital stay: Most people who have a laparoscopic appendectomy go home the same or next day. Recovery from an open appendectomy may take longer, with a hospital stay of a few days.
• Postoperative care: Rest and avoid strenuous activity for a few weeks. Follow the surgeon’s instructions regarding wound care and gradually resume normal activities.
• Complications: Watch for signs of infection, such as redness, swelling, or pus around the incision, and report fever or increasing pain to your doctor.

Prevention of Appendicitis:

There is no guaranteed way to prevent appendicitis, but a diet high in fiber, including fruits, vegetables, and whole grains, may reduce the risk of developing it. Fiber helps promote regular bowel movements and reduces the chance of blockages.

When to Seek Medical Attention:

Seek immediate medical care if you experience symptoms of appendicitis, especially if you have severe abdominal pain, fever, nausea, or vomiting. Appendicitis is a medical emergency that requires prompt diagnosis and treatment to prevent serious complications.

Conclusion:

Appendicitis is a common medical emergency that can have serious consequences if not treated quickly. Early recognition and prompt surgical removal of the appendix typically result in a full recovery. While appendicitis cannot always be prevented, maintaining a healthy diet and seeking medical attention at the first sign of symptoms can help avoid complications like rupture and infection.