Appendicitis – Symptoms, Diagnosis and Treatment
Appendicitis is an inflammation of the appendix, a worm-shaped pouch attached to the colon on the lower right side of the abdomen. Although this small organ serves no known purpose today, it is believed that at one time in the past the appendix may have played a role in digestion.
Sometimes, the appendix becomes inflamed and fills with pus. At this stage it causes sudden pain that begins near the belly button and gradually moves to the lower right abdomen. Over time, the pain worsens and becomes severe while the appendix may rupture. A ruptured appendix requires immediate medical intervention because it can lead to a life-threatening infection called peritonitis.
Although appendicitis affects people of all ages, it is more common between the ages of 10 and 30 and most common in adolescents. It is rare in children younger than one year, though.
The exact cause of appendicitis may not be always known. Several different factors are thought to trigger this condition. These include infection in the digestive tract that allows bacteria to invade the appendix and food waste or a hard piece of stool that becomes lodged in the entrance to the appendix or inside the cavity. In addition, a traumatic injury to the abdomen can in some rare instances cause appendicitis. Genetics may also play a role, as some people are genetically more susceptible to obstruction of the appendix.
Appendectomy, a surgical removal of the appendix, is the standard treatment for appendicitis. It happens to be the most common emergency surgical procedure of the abdomen. Appendicitis must be treated promptly to prevent peritonitis, a condition that may be even fatal.
Signs and Symptoms of Appendicitis
Appendicitis usually begins with the pain around the belly button that gradually shifts to the lower right abdomen. As the inflammation spreads to the tissues surrounding the abdomen the pain becomes worse. The pain usually settles halfway between the belly button and the top of the right pelvic bone. However, irrespective of where the pain settles, the area tends to feel tender when pressure is applied. If this pressure is released quickly, the pain may worsen. This is called rebound tenderness. Walking, coughing, sneezing or taking deep breaths may also worsen the pain.
Other symptoms commonly associated with appendicitis include:
- Abdominal swelling
- Frequent need to urinate
- Inability to pass gas
- Loss of appetite
- Low-grade fever
- Nausea and vomiting
If appendicitis is not treated immediately, it can result in a rupture of the appendix. Paradoxically, this may initially cause the patient to feel better as the pressure is released. However, a release of the contents of the intestines and infectious microorganisms into the peritoneal cavity can cause peritonitis, an extremely dangerous infection of the lining of abdominal cavity.
Once the appendix ruptures, the patient’s abdomen will feel hard, tight and tender to the touch. Widespread abdominal pain may result while the patient may find it impossible to have a bowel movement or pass gas. Other symptoms frequently associated with peritonitis include worsening pain and fever, reduced urine output and excessive thirst. Young children may also become disoriented and faint. Peritonitis is an emergency situation, requiring immediate medical attention.
One of the potential complications of peritonitis is abscess, a walled-off area of infection outside the intestine, which may range in size from a walnut to a grapefruit. Bacteria from a rupture can also infect woman’s ovaries and fallopian tubes, resulting in infertility and can enter the bloodstream, leading to a life-threatening condition called sepsis.
Some patients with appendicitis experience symptoms normally associated with this condition, while others, such as pregnant women, young children or elderly, may not. Since pregnant women often do not experience classic symptoms of appendicitis, they should consult a doctor if they experience pain on the right side of their abdomen, especially during their third trimester. Moreover, patients with certain conditions, such as diabetes, obesity, cancer and HIV, and those who have received a transplanted organ or are undergoing immunosuppressive therapy may experience a general feeling of sickness rather than specific symptoms of appendicitis.
Appendicitis is in its initial stage often difficult to diagnose, particularly in young children. The condition can become very serious once an appendix has ruptured and caused peritonitis. Since children are more likely to suffer a ruptured appendix, parents should consult a doctor anytime their child has a pain in abdominal area that appears to be unusually severe.
As a first step in diagnosing appendicitis, a complete physical examination will be performed and a patient’s thorough medical history will be compiled. The doctor will apply gentle pressure to the abdomen, releasing it quickly. If the pain worsens, this may indicate an inflamed peritoneum. The typical symptoms of appendicitis include abdominal rigidity, patient’s instinct to tense the abdominal muscles when pressure is applied and the pain the patients experience when they lie on the left side and extend their right leg.
A blood test may be ordered to check for an elevated white cell count indicative of an infection. A urine test can help determine the presence of other conditions with similar symptoms, such as a urinary tract infection or kidney stone.
Imaging tests, including an x-ray, ultrasound scan, magnetic resonance imaging (MRI) and especially a computed axial tomography (CAT) scan, are used to help distinguish between appendicitis and another condition such as gallbladder disease. Disorders, which symptoms may appear similar to those of appendicitis, include:
- Digestive disorders, which share the symptoms of appendicitis include gastroenteritis, Crohn’s disease, Meckel’s diverticulum, diverticulitis and intussusception.
- Kidney stone from the right kidney may become stuck in the ureter, causing abdominal pain that resembles appendicitis.
- Urinary tract infection that can occur along any part of the urinary tract may also cause pain similar to that of appendicitis.
- Ectopic pregnancy is a pregnancy that occurs outside the uterus. It can cause pain similar to that of appendicitis.
- Pelvic inflammatory disease is an infection of female internal reproductive organs. Pain associated with this inflammatory disease may mimic the symptoms of appendicitis.
- Ovarian cysts, which develop on the right ovary may sometimes resemble the symptoms of appendicitis.
- Other illnesses that may cause abdominal pain resembling that of appendicitis include heart disease and pneumonia.
Treatment of Appendicitis
Although appendicitis cannot be prevented, it can be treated effectively with surgery and medication. The body is rarely successful in containing the appendicitis without surgical intervention. Therefore, the standard treatment for appendicitis, called appendectomy, involves removal of the appendix through traditional open surgery or laparoscopic surgery. Antibiotics may be given to slow the spread of infection.
In laparoscopic surgery, a thin tube called laparoscope is inserted into one of the incisions made into the abdomen through a hollow instrument called cannula. The laparoscope has a camera with a micro torchlight attached to it, which provides a magnified view of the interior of the abdomen on a monitor. A surgeon then inserts instruments into the other incisions to remove the appendix. The advantages of laparoscopic surgery are less pain, fast recovery and minimum scarring.
However, in cases when the appendix has ruptured or an abscess has developed, traditional open surgery will likely be used. A larger incision will be made than in laparoscopic surgery in order to wash out the abdomen with fluid. Temporary drains may also be needed. Traditional open surgery typically requires intravenous antibiotics and a longer hospital stay and recovery period than laparoscopic surgery. To reduce the risk of infection, antibiotics may be administered immediately after the surgery.
In rare cases, patients who had their appendix removed may experience another episode of appendicitis called stump appendicitis. Stump appendicitis is an inflammation of the small part of the appendix that remains there after the procedure and will require another surgery to remove it completely. This situation can be prevented by leaving a very tiny stump of less than three millimetres long in the original surgery.