Appendicitis
What is appendicitis?
Appendicitis is an infection of the appendix (a small, hollow, finger-like structure that branches off the large intestine). Early in life, the appendix functions as a part of the immune system, but in later years the appendix stops functioning and other organs such as the spleen and bone marrow continue to help fight infection. Although the appendix does not seem to serve any purpose, it can become irritated, inflamed, and diseased. If untreated, it can burst, causing infection to spread through the body. Severe illness, shock, and even death could occur.
What are the symptoms of appendicitis?
The following are the most common symptoms of appendicitis. However, each individual may experience symptoms differently. Symptoms may include:
- nausea and vomiting
- loss of appetite
- fever and chills
- pain in the abdomen which:
- usually increases in severity as time passes.
- may start in the area around the belly button, and move over to the lower right-hand side of the abdomen, but may also start in the lower right-hand side of the abdomen.
- may be worse with moving, taking deep breaths, being touched, and coughing or sneezing.
- may spread throughout the abdomen if the appendix ruptures
- constipation
- diarrhea
- inability to pass gas
- abdominal swelling
It is important that persons with symptoms of appendicitis not take laxatives or enemas to relieve constipation, as these medications and procedures can cause the appendix to burst. In addition, persons should also avoid taking pain medication, as this can mask other symptoms the physician needs to be aware of.
The symptoms of appendicitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.
What are the causes and risk factors for appendicitis?
Appendicitis occurs when the interior of the appendix becomes obstructed from material that causes it to swell, such as mucus, stool, or parasites. The appendix can becomes irritated and inflamed. The blood supply to the appendix is choked off as the swelling and irritation increase. Adequate blood flow is necessary for a body part to remain healthy. When blood flow is reduced, the appendix starts to die. Rupture (or perforation) of the appendix occurs when holes develop in the walls of the appendix, allowing stool, mucus, and other substances to leak through and get inside the abdomen. A critical, life threatening infection inside the abdomen known as peritonitis can occur when the appendix perforates.
Appendicitis may occur after a viral infection in the digestive tract or when the tube connecting the large intestine and appendix is blocked or trapped by stool. Because of the risk of rupture, which may occur as soon as 48 to 72 hours after symptoms begin, appendicitis is considered an emergency and anyone with symptoms needs to see a physician immediately.
Appendicitis affects 7 percent of the US population and is the most common reason for a child to need emergency abdominal surgery. About one in 500 people has appendicitis each year.
Most cases of appendicitis occur between the ages of 11 and 20 years. Most cases of appendicitis occur in the winter months - between October and May. Having a family history of appendicitis may increase a child's risk for the illness, especially in males, and having cystic fibrosis also seems to put a child at higher risk.
How is appendicitis diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for appendicitis may include the following:
- Blood tests (to check for signs of infection such as elevated white blood cell count)
- Urine tests (to rule out a urinary tract infection)
- Imaging procedures, including the following:
- Abdominal ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
- Computed tomography scan of the abdomen, with or without barium (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
- Lower GI (gastrointestinal) series (also called barium enema) - a procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is given into the rectum as an enema. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.
Treatment for appendicitis:
Specific treatment for appendicitis will be determined by your physician based on your:
- age, overall health, and medical history
- tolerance of specific medicines, procedures, or therapies
- expectations for the course of the condition
- opinion or preference
- extent of condition
Because of the likelihood of the appendix rupturing and causing a severe, life-threatening infection, physicians will typically recommend that the appendix be removed with an operation.
The appendix may be removed in two ways:
1. open method
Under anesthesia, an incision is made in the lower right-hand side of the abdomen. The surgeon finds the appendix and removes it. If the appendix has ruptured, a small drainage tube may be placed to allow pus and other fluids that are in the abdomen to drain out. The tube will be removed in a few days, when the surgeon feels the abdominal infection has subsided.
2. laparoscopic method
This procedure uses several small incisions and a camera called a laparoscope to look inside the abdomen during the operation. Under anesthesia, the instruments the surgeon uses to remove the appendix are placed through several small incisions, and the laparoscope is placed through another incision. This method is not usually performed if the appendix has ruptured.
Antibiotics, such as cefazolin and metronidazole (Flagyl), may be administered to prevent surgical wound infection
Typically, without a rupture, recovery after an appendectomy is just a few days. If the appendix has ruptured, recovery is longer and antibiotics are necessary.
You can live a completely normal life without your appendix. Changes in diet, exercise, or other lifestyle modifications are usually not necessary.
References:
1. Pittman-Waller, VA, Myers, JG, Stewart, RM, et al. Appendicitis: Why so complicated? Analysis of 5755 consecutive appendectomies. Am Surg 2000; 66:548
2. Terasawa, T, Blackmore, CC, Bent, S, Kohlwes, RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med 2004; 141:537.
3. Flum, DR, McClure, TD, Morris, A, Koepsell, T. Misdiagnosis of appendicitis and the use of diagnostic imaging. J Am Coll Surg 2005; 201:933.
4. Schuler, JG, Shortsleeve, MJ, Goldenson, RS, et al. Is there a role for abdominal computed tomographic scans in appendicitis? Arch Surg 1998; 133:373.
5. Hof, KH, van Lankeren, W, Krestin, GP, et al. Surgical validation of unenhanced helical computed tomography in acute appendicitis. Br J Surg 2004; 91:1641.
Copyright 2007, MD Kiosk
