APPENDICITIS

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/APPENDICITIS

Appendicitis is simply an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases especially on the right side of the abdomen and eventually becomes severe.

CAUSES OF APPENDICITIS

Appendicitis is caused by a blockage of the hollow portion of the appendix. The causative agents of appendicitis include bezoars, foreign bodies, trauma, intestinal worms, lymphadinitis and most commonly, hardened fecal deposits that are known as appendicoliths or fecaliths. Inflamed lymphoid tissue from a viral infection, parasites, gallstone, or tumors may also cause the blockage. This blockage causes increased pressures in the appendix, decreased blood flow to the tissues of the appendix and bacterial and multiplication growth inside the appendix causing inflammation. Once this obstruction occurs, the appendix becomes filled with mucus and swells. This continued production of mucus leads to increased pressures within the lumen and the walls of the appendix. The combination of inflammation, reduced blood flow to the appendix and distention of the appendix causes tissue injury and tissue death. If this process is left untreated, the appendix may burst, releasing bacteria into the abdominal cavity, leading to increased complications and eventually death if left untreated.

COMPLICATIONS OF APPENDICITIS

Appendicitis can cause serious complications, such as:

  • A ruptured appendix is one of the commonest complications of appendicitis. The rupture spreads infection throughout your abdomen (peritonitis). This is a painful inflammation of the abdominal wall. Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity.
  • If the appendix bursts, there may development of a pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through the abdominal wall into the abscess to drain it. Once the infection is clear, surgery will be done to remove the appendix. In some cases, the abscess is drained, and the appendix is removed immediately.

SYMPTOMS OF APPENDICITIS

Common symptoms and signs of appendicitis usually include the following:

  • Sudden pain that begins around your navel and often shifts to your lower right abdomen
  • Pain at the right abdominal area
  • Nausea and vomiting
  • Loss of appetite
  • Fever that may worsen ad the illness progresses
  • Constipation or diarrhea
  • Abdominal bloating
  • Flatulence

DIAGNOSIS

Diagnosis is based on a medical history (symptoms) and physical examination, which can be supported by an elevation of neutrophilic white blood cells and imaging studies if needed. Typical appendicitis includes several hours of generalized abdominal pain that begins in the region of the umbilicus with associated anorexia, nausea, or vomiting. The pain then “localizes” into the right lower part of the abdomen where the tenderness increases in intensity. It is possible the pain could localize to the left lower quadrant in people with situs inversus totalis.

MANAGEMENT

Acute appendicitis is typically managed by surgery. While antibiotics are safe and effective for treating uncomplicated appendicitis, 26% of people had a recurrence within a year and required an eventual appendectomy. Surgery is the standard management approach for acute appendicitis. Using antibiotics to prevent potential postoperative complications in emergency appendectomy procedures is recommended and the antibiotics are effective when given to a person before, during, or after surgery.

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