APPENDICITIS: Abdominal pain with a difference!

Appendicitis is inflammation of the appendix. The appendix is a small, pouch-like sac of tissue that is located in the lower- right abdomen. It is a narrow tubular pouch attached to the intestines. When mucus, stool, or a combination of the two blocks the opening of the appendix that leads to the first part of the colon, it becomes inflamed and results in appendicitis. If bacteria proliferate in the trapped space and infect the lining of the appendix. If the inflammation and blockage are severe enough, the tissues begin to die from a lack of blood supply, which finally results in perforation or rupture of the appendix. This is a medical emergency.

Symptoms

One of the first symptoms of appendicitis is abdominal pain that is hard to localise. The pain usually occurs suddenly before other symptoms, often causing a person to wake up at night. It begins near the belly button and then moves lower and to the right. It is new and unlike any pain felt before. It gets worse in a matter of hours, when moving around, taking deep breaths, coughing, or sneezing.

Loss of appetite is another early symptom of appendicitis. Nausea and vomiting may occur early in the course of the illness or even later as the result of an intestinal obstruction.

Other symptoms of appendicitis may include constipation or diarrhoea, inability to pass gas and a low-grade fever that follows other symptoms. Others are abdominal swelling, and the feeling that passing stool will relieve discomfort.

Who is affected?

Appendicitis is a common condition affecting individuals of any age. Anyone can get appendicitis, but it occurs most often in people between the ages of 10 and 30. Very young children and elderly people are at higher risk of complications due to appendicitis. The highest incidence occurs in the teens and 20s, but rare cases of neonatal and prenatal appendicitis have been reported. It is actually one of the most common paediatric conditions requiring emergency abdominal surgery. Early recognition and prompt treatment of the condition are necessary.

Complications

Delaying the diagnosis and treatment of appendicitis increases the risk of complications. One potential complication (perforation) can lead to an accumulation of pus (abscess) around the appendix or an infection that spreads throughout the abdominal lining and that of the pelvis (peritonitis).

Surgery should occur as soon as possible after the diagnosis of appendicitis. Longer delays between diagnosis and treatment (surgery) increase the risk of perforation. For example, the risk of perforation 36 hours after appendicitis symptoms first appear is 15 per cent or more.

Sometimes the inflammation associated with appendicitis interferes with the action of the intestinal muscle and prevents bowel contents from moving.

Nausea, vomiting, and abdominal distention can occur when liquid and gas build up in the part of the intestine above the blockage. In these cases, the insertion of a naso-gastric tube (tube inserted into the nose and advanced down the gullet into the stomach and intestines) may be necessary to drain the contents that cannot pass.

Diagnosis

Doctors diagnose appendicitis based on the patient’s symptoms and findings during physical examination. A person with appendicitis usually experiences moderate-to-severe pain when the doctor gently pushes down on the lower right abdomen. A potential indication of peritonitis is “rebound tenderness,” which is a worsening of pain when the doctor removes his hand after pressing down on a tender area of the abdomen. Although no blood test can confirm appendicitis, a blood sample is sent for laboratory analysis to check the while blood cell count that is typically elevated in an individual with appendicitis.

A urinalysis may be ordered to exclude urinary tract infection or pregnancy. A Computerised tomography (CT scan) of the abdomen and pelvis can assist in evaluating abdominal pain suspected of being caused by appendicitis. Other conditions that cause abdominal pain may mimic the symptoms of appendicitis making the diagnosis more difficult. These conditions include kidney stones, UTIs, hernias, gallbladder problems and ovarian or testicular problems.

When to seek medical care

Call a doctor if there are acute symptoms of middle/lower or right/lower abdominal pain with fever and/or vomiting. If symptoms of abdominal pain continue for more than four hours, an urgent medical evaluation should be performed at the doctor’s office or a hospital’s emergency department.

Treatment

Appendicitis cannot be treated at home. If you suspect you have appendicitis, see your doctor or go to an emergency department. Avoid eating or drinking as this may complicate or delay surgery. If you are thirsty, you may rinse your mouth with water. Do not use laxatives, antibiotics or pain medications because these may cause delay in diagnosis that increases the risk of rupture of the appendix or masks the symptoms, making diagnosis more difficult.

Appendectomy

The best treatment for appendicitis is surgical removal before the appendix ruptures. The surgery is called appendectomy. Antibiotics are given to a patient with suspected or confirmed appendicitis both before and after surgery. Appendectomies can be performed through pin-hole surgery, where special surgical tools are advanced into the abdomen via several small incisions. After an uncomplicated appendectomy, recovery time can vary from 2 to 6 weeks. The individual may gradually resume a normal diet with restriction in physical activity for at least 2 to 4 weeks. The doctor will inspect the incision the following week to look for possible infection.

Prevention

There is no way of predicting when appendicitis will occur or prevent it from occurring.

There are no proven risk factors for appendicitis. It has been suggested that potential risk factors may include a diet low in fibre and high in sugar, family history, and infection. There are no proven risk factors for appendicitis. It has been suggested that potential risk factors may include a diet low in fibre and high in sugar, family history, and infection.

The appendix plays an uncertain role in adults and older children and it removal is not associated with any major long-term health problems. Some studies report an increased risk of certain diseases such as Crohn’s disease, which is an inflammatory intestinal condition, after an appendectomy.