The appendix is a narrow tubular pouch attached to the intestines. When the appendix is blocked, it becomes inflamed and results in the condition known as appendicitis. If the blockage continues, the inflamed tissue becomes infected with bacteria and begins to die from a lack of blood supply, which finally results in the appendix bursting Appendicitis is a common condition that affects 7% of the population, according to the American Academy of Family Physicians. Persons of any age may be affected, with the highest incidence occurring during the second and third decades of life. Rare cases of neonatal and prenatal appendicitis have been reported.
There is no clear cause of appendicitis. Fecal material is thought to be one possible obstructing object. Bacteria, viruses, fungi, and parasites can be responsible agents of an infection that leads to swelling of the tissues of the appendix wall, including Yersinia species, adenovirus, cytomegalovirus, actinomycosis, Mycobacteria species, Histoplasma species, Schistosoma species, pinworms, and Strongyloides stercoralis. Also, swelling of the tissue from inflammatory bowel diseases such as Crohn`s disease may cause appendicitis. It appears that appendicitis is not hereditary or transmittable from person to person
Appendicitis typically begins with a vague pain in the middle of the abdomen often near the navel or belly button (umbilicus). The pain slowly moves to the right lower abdomen (toward the right hip) over the next 24 hours. In the classic description, abdominal pain is accompanied with nausea, vomiting, lack of appetite, and fever. All of these symptoms, however, occur in fewer than half of people who develop appendicitis. More commonly, people with appendicitis have any combination of these symptoms. Symptoms of appendicitis may take 4-48 hours to develop. During this time, someone developing appendicitis may have varying degrees of loss of appetite, vomiting, and abdominal pain. Some may have constipation, diarrhea, or there may be no change in bowel habits. Early symptoms are often hard to separate from other conditions including gastroenteritis (an inflammation of the stomach and intestines).true appendicitis is often mis-diagnosed as gastroenteritis initially. Children and the elderly often have fewer symptoms, which makes their diagnosis less obvious and the incidence of complications more frequent.
When to Seek Medical Care
Call the 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 done at the doctor`s office or the hospital`s emergency department.
Although no blood test can confirm appendicitis, a blood sample is sent for laboratory analysis to check the white blood cell count, which is typically elevated in an individual with appendicitis. However, normal levels can be present with appendicitis, and elevated levels can be seen with other conditions. A urine test may be performed to exclude urinary tract infection (or pregnancy) as the cause of the symptoms.
Appendicitis is diagnosed by the classic symptoms and the physical exam (the doctor`s examination of the patient`s abdomen). Imaging tests are used when the diagnosis is not readily apparent. Most medical centers now use a CT scan of the abdomen and pelvis to help evaluate abdominal pain suspected of being caused by appendicitis. Ultrasound scanning is currently commonly used in small children to test for appendicitis.
Treatment Self-Care at Home
There is no home care for appendicitis. If the condition is suspected, contact a doctor or go to an emergency department. Avoid eating or drinking as this may complicate or delay surgery.Do not take (or give your child) laxatives, antibiotics, or pain medications because these may cause delay in diagnosis that increases the risk of rupture of the appendix or mask.
Surgery The best treatment for appendicitis requires surgery to remove the appendix (the operation is called an appendectomy)ï¿½ before the appendix opens or ruptures. While awaiting surgery, the patient will be given IV fluids to keep hydrated. The patient will not be allowed to eat or drink because doing so may cause complications with the anesthesia during surgery. Surgery is commonly done laparoscopically (through small incisions using a camera in the abdominal cavity). However, in some cases it may be necessary to do an open abdominal procedure to take the appendix out. Up to 20% of surgeries for appendicitis reveal a non-inflamed appendix (negative appendectomy). The difficulty in making a definite diagnosis of this medical problem and the risk of missing the acutely inflamed appendix (and the patient becoming very ill due to perforation) makes a certain rate of misdiagnosis inevitable. Women in particular have a high rate of negative appendectomy as ovarian and uterine problems make the diagnosis more difficult. CT scanning prior to surgery has been shown to decrease this percentage to closer to 7%-8% in women.
Follow-up After an uncomplicated appendectomy, the patient may gradually resume a normal diet with a restriction in physical activity for at least two to four weeks. The doctor will check the incision the following week to look for possible wound infection.
Outlook With uncomplicated appendicitis, most people recover with no long-term problems. If the appendix ruptures, there is a greater than 10 times risk of complications, including death. This increase in risk generally is found in the very young, elderly, and those with weakened immune systems, including people with diabetes. Whether a perforated appendix is a significant risk for infertility has not been well established. Some experts recommend that this be considered in young women who might be at risk.