Appendicitis - Causes, Symptoms, Diagnosis & Treatment
Health Education

Appendicitis

Authored by Dr.Mohan Rao on 19 Dec 2014 - 10:41

Appendicitis is inflammation of the appendix, a fingerlike pouch attached to the large intestine in the lower right side of the abdomen. It is a medical emergency and is recognized as one of the most common and significant causes of severe abdominal pain worldwide.

Obstruction in the lumen of the appendix results in mucus accumulation, which assists the intestinal bacteria in its multiplication process eventually leading to inflammation and infection of the appendix.

Blockage may take place due to:

  • Stool
  • Parasite
  • Enlarged lymph tissue
  • Ulcers resulting from Inflammatory Bowel Diseases (IBD)
  • Abdominal trauma.

The first symptom observed in appendicitis is pain followed by vomiting and fever. Pain begins at the navel and shifts to lower right side of the abdomen. Severity of pain gradually increases with time and it worsens during coughing or walking movements.

Other symptoms which may also be seen are:

  • Anorexia
  • Constipation
  • Lower right abdominal tenderness
  • Inability to pass gas
  • Diarrhea
  • Abdominal swelling

Appendicitis is a condition which is a diagnostic and treatment challenge. Diagnostic challenge is because of complexity of its differential diagnosis and also various anatomical positions of appendix: it can be confused with: Renal stone, ovarian cyst, tubal pregnancy, acute cholecystitis, tubo-ovarian abscess, pelvic inflammatory disease, acute gastroenteritis, diverticulitis, endometriosis and urinary tract infection.

No single evaluation can substitute for diagnostic accuracy of experienced physicians. Imaging studies are not useful in diagnosis.Use of anti-spasmodic agents or pain killers prior to diagnosiscan lead to missing the evolving complications like rupture of appendix.

Accurate diagnosis and prevention of rupture of appendix is still a major challenge today.Medical history and physical examination are enough in majority of cases to diagnose the condition. If patients are unable to explain their symptoms (children) or to rule out other conditions with similar symptoms, certain tests are performed:

  • Blood tests: Fluid and electrolyte levels are assessed
  • Urinalysis: Urinary Tract Infection (UTI) or kidney stones are ruled out
  • Pregnancy test: is performed in women to rule out pregnancy as the cause of pain
  • Imaging tests: deliver images which can show signs of inflammation or blockage. Different tests used are:
  • X-ray
  • Ultrasound
  • MRI
  • CT-scan

COMPLICATIONS:

Appendicitis should be treated on time as it may lead to severe complications such as:

  • Rupture (bursting of appendix)
  • Abscess (collection of pus)
  • Peritonitis (inflammation of the inner wall of intestines)

Although there are no particular risks associated with appendicitis, majority of the cases are linked to the following:

  • Age between 10 and 30
  • Diet low in fiber and high in sugar
  • Family history
  • Infection

Treatment of Appendicitis usually involves appendectomy (surgery to remove the inflamed appendix), which can be performed in any of the two ways:

Laparotomy:

It is the traditional way of surgery which a single incision of 2-3 inches is made in the lower right side of abdomen to remove appendix. 10-14 days of rest should be taken after surgery.

Laparoscopy:

It is minimally invasive surgery with multiple small incisions to remove appendix with the use of advanced tools. It can hide post operation scars and can be used if diagnosis is in doubt. Further it can reduce the risk of post surgery complications and takes less time for recovery. 3-5 days of rest should be taken before getting back to work.

‘Confined Appendicitis’ is seen in some of the patients where the inflamed portion does not affect other areas of the body. Antibiotics can help treat these patients without surgery.

Antibiotics belonging to the class of Cephalosporins are used before and after the surgery to fight infections. These drugs can be stopped once WBC count normalizes and patient becomes afebrile (not feverish).

Lifestyle modification:

  • Avoid activities involving physical stress
  • Support your abdomen while you cough, laugh or other similar movements
  • A low enema of warm water should be given every day to cleanse the lower bowel.
  • Constipation should be treated immediately as it can further aggravate the inflammation of appendix
  • Diet should consist of coarse cereals, vegetables and fruits.
  • Soluble fibers should also be included in the diet to promote healthy bowel movements.
*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.