Appendicitis

What is appendicitis?

Appendicitis is inflammation of the appendix. The appendix is located in the right lower abdomen at the lower end of the colon. (See Figure 1) To this date, researchers still have not found the purpose of the appendix.

Figure 1: The Appendix

Photo Courtesy of: colonista.com

The appendix is a small sack like structure that protrudes from the colon wall. This sack can become filled with debris and colon material and become inflamed and infected. This can cause intestinal blockage and the infection can spread to the entire abdomen.

This condition is most common among older children and younger adults between the ages of 10 and 30 years of age. The symptoms can often mimic other conditions and are hard to diagnose. Many appendicitis sufferers will put off treatment too long and the complication of untreated appendicitis is sepsis, where the infection enters the bloodstream. This complication requires extensive antibiotic treatment in the hospital and can be fatal.

Any infection or inflammation in the appendix is an emergency and anyone with signs or symptoms of appendicitis must be evaluated right away. This will prevent serious complications and the spread of the infection to other parts of the body. The pus resulting from appendicitis can also spread throughout the abdominal cavity, resulting in a condition called peritonitis. (See Figure 2)

Figure 2: Inflamed Appendix

Photo Courtesy of: WebMD.com

What causes appendicitis?

It is not completely understood why appendicitis occurs. The condition may be the result of a secondary bacterial infection after someone has had a virus. Viral infections of the abdomen can cause the intestines to slow down and become blocked preventing the appendix from emptying itself. The contents then become stagnant and allow for bacterial growth. This is where many people may avoid medical care, thinking they just have a stomach virus.

Normally the appendix is able to clean itself out periodically with normal bowel movements. If the opening to the appendix becomes blocked then it can become infected quickly and the infection can spread in a matter of hours. (See Figure 3)

Figure 3: Intestinal Blockage

Photo Courtesy of: Pennmedicine.org

On rare occasion, intestinal tumors or cancer can be the cause of appendicitis. Also, abdominal surgery in other areas of the abdomen can cause scar tissue that can constrict and block the area of the appendix. This is why post-surgical patients are encouraged to stay on a clear liquid diet until bowel sounds fully return after surgery. Eating with a “sleepy” bowel can cause obstruction.

What are the symptoms of appendicitis?

Appendicitis symptoms can come slowly and be vague. This is why many people delay evaluation and treatment. The first symptom is usually pain around the belly button. Some people also experience pain in the left lower abdomen, leading them away from the thought of appendicitis. This is called referred pain. Other symptoms can include;

• ·         Pain in the lower right abdomen 12 to 24 hours after belly button pain starts
• ·         Minimal or no appetite
• ·         Nausea
• ·         Vomiting
• ·         Low grade fever 99◦ F to 101◦ F
• ·         Pain with coughing or sneezing
• ·         Chills
• ·         Diarrhea
• ·         Constipation
• ·         Pain on rebound when the abdomen is pressed
• ·         Not passing gas
• ·         Sudden pain and then relief (In cases of rupture)

These symptoms are especially serious if they follow recent abdominal surgery. This could indicate an intestinal blockage and appendicitis is a secondary infection. If you have any symptoms of appendicitis, it is extremely important not to have anything to eat or drink on the way to the hospital. They will want you fasting in case you need emergency surgery.

How is appendicitis diagnosed?

Appendicitis can be diagnosed with imaging studies such as; CT scan, abdominal x-ray and ultrasound. The doctor may also order these lab tests to check for infection and electrolyte loss due to vomiting or diarrhea:

Complete Blood Count Checks for the amount of white blood cells in the bloodstream and is a strong indicator of infection in the body. This test will help the doctor make the decision if the patient needs antibiotic treatment in the hospital prior to surgery.

Renal Panel Checks the electrolytes in the body such as; sodium and potassium. These electrolytes are lost from vomiting and diarrhea resulting in dehydration. People who lose these electrolytes need to have them replaced quickly.

Urinalysis Appendicitis and Kidney stones or bladder infections can mimic each other. The doctor will run a urinalysis to help confirm that the symptoms are truly appendicitis and not a urinary cause. This can also help the doctor see the degree of dehydration in a patient.

How is appendicitis treated?

Uncomplicated appendicitis is treated with surgery as soon as the patient is stable. If the infection has not spread to other areas of the abdomen or the bloodstream, a surgeon will remove the appendix. This is usually a quick procedure and the patient is released from the hospital within one day.

If the appendicitis becomes complicated by the spread of infection, the patient will need to be hospitalized on intravenous antibiotics until the infection is cleared. This could take days and up to weeks depending on how bad the infection became. This is usually the result of delaying evaluation and treatment.

The surgeon will remove the appendix after the infection has cleared, possible in the same hospital stay but sometimes the surgeon will allow the patient to completely recover and schedule the surgery for a date in the near future. The patient is then sent home on a clear liquid or soft diet to recover until surgery is performed.

Other reasons the surgeon may delay surgery is when the diagnosis of appendicitis is questioned. This is especially common in young children where appendicitis can be difficult to diagnose. The structures in and around the area of the appendix are so tiny that it may be hard to see on ultrasound or CT that the appendix is actually inflamed.

How can appendicitis be prevented?

The only preventative measure with appendicitis is complying with bowel rest after surgery or during a viral abdominal infection. If you have either of these conditions, it is extremely important to take only clear liquids and advance the diet slowly as bowel function returns. (See Figure 4)

Figure 4: Clear Liquid Diet

Photo Courtesy of greatredsharkblog.com

In cases where the cause of appendicitis occurs without explanation, there is no prevention. Researchers still cannot explain why many cases of appendicitis happen; therefore it is not completely clear what can be done to prevent them.

Conclusion

Appendicitis is a dangerous condition and anyone with signs or symptoms of this condition needs to be evaluated immediately in the emergency room. The appendix can rupture and cause severe complications very quickly if left untreated.

Always follow your doctor’s orders and stay on clear liquids until the bowels are functional to prevent intestinal blockage, prior to appendicitis and after having the appendix removed. With good compliance, the complications of appendicitis can be minimized.