Appendicitis

Overview

An appendix is a small tube-shaped pocket at the end of the large intestine. Appendicitis occurs when the appendix is obstructed and inflamed. The condition may also result from bacterial, viral or parasitic infection in the digestive tract. It can occur in the form of chronic or acute type.

In appendicitis, the blood supply to the appendix is restricted due to the swelling in the area. In the absence of enough blood flow, the cells in the appendix begin dying. Additionally, the blockage provides ample space for microorganisms like bacteria to fester and cause infections.

In the prolonged presence of appendicitis, the walls of the appendix may rupture, causing the leaking of stool outside the organ in the gastrointestinal system. This can cause a life-threatening disease called peritonitis.

After the onset, the condition causes symptoms like abdominal pain, low-grade fever, travelling pain from the navel to the lower abdomen, constipation, diarrhoea, vomiting, difficulty releasing gas and more. The symptoms vary from one person to another. In pregnant women, the symptoms may appear similar to the regular discomforts faced during pregnancy, like bloating. Additionally, in these patients, the pain doesn't occur in the lower abdomen. Instead, it appears on the upper side of the organ.

Within 24 hours of the symptoms' appearance, the chances of facing a rupture increase. That's the reason it's imperative to get medical help as soon as the signs start occurring.

Generally, the doctor recommends a series of tests to understand the severity of the appendicitis. The prescribed tests include blood tests, urine assessments, abdominal ultrasound or CT scans.

After a positive diagnosis, experts suggest surgery, which can be of two types, i.e., open and laparoscopic. In appendix surgery or appendectomy, the general surgeon removes the appendix.

Types of Appendicitis: 

Acute appendicitis is characterized by the sudden onset of severe symptoms that can quickly worsen.
Chronic appendicitis occurs when the appendix is inflamed for an extended period of time, causing intermittent symptoms.

Symptoms:

The symptoms of appendicitis may include:

• Sudden pain on the right side of the lower abdomen.

• Sudden pain around the navel that frequently spreads to the lower right abdomen.

• Pain worsens when coughing, walking, or performing other jarring movements.

• Nausea and vomiting.

• Loss of appetite.

• Low-grade fever, which may increase as the illness progresses.

• Constipation and/or diarrhea.

• Abdominal bloating.

• Gas.

The pain's location may vary depending on age and appendix position. Pregnancy pain may appear to originate in the upper abdomen because the appendix is elevated.

Causes:

Appendicitis is most commonly caused by a blockage in the appendix's lining. This obstruction can result in an infection. The bacteria multiply quickly, causing the appendix to become inflamed, swollen, and pus-filled. If not treated immediately, the appendix can rupture.

Risk factors for appendicitis:

Age: Appendicitis is most common in teenagers and young adults, but it can happen at any age.

Sex: Appendicitis is more common in men than in women.

Family history: People with a family history of appendicitis have a higher risk of developing it.

Complications:

Appendicitis can lead to serious complications if your appendix ruptures, allowing faeces and bacteria to enter your abdomen. A ruptured appendix can cause painful and potentially life-threatening infections, such as peritonitis, abscesses, and sepsis.
Your doctor may recommend antibiotics, surgery, or other treatments to help you avoid or manage complications. Some treatments may cause side effects or complications. However, the risks of antibiotics and surgery are far less common and typically less serious than the complications of untreated appendicitis.

Prevention:

There is no sure way to prevent appendicitis. However, eating a fibre-rich diet may help lower your risk of developing it.
 

When to Consult a Doctor?

• On Symptoms

Patients must seek medical attention as soon as they witness symptoms. The symptoms can range from shooting pain in the lower right side of the abdomen to discomfort in the area. The typical signs of appendicitis are fever, difficulty passing gas and stool, bloating, pain interrupting sleep and more.

Since the disease can progress into a life-threatening form called Peritonitis due to the rupture of the appendix, urgent medical attention is of extreme importance. In the event of a rupture, the collected excreta or pus may spread to the other parts of the gastrointestinal system leading to infection.

• Routine Checkup

Regular checkups, in case of mild symptoms, are more important if a woman is pregnant. During pregnancy, the signs of appendicitis resemble the usual inconvenience caused by the bulging abdomen, like flatulence and cramps. This similarity makes it difficult to differentiate between the symptoms of other diseases. Delayed treatment of appendicitis during pregnancy can result in fetal and maternal complications.

• After Medications

Generally, doctors recommend various medications, including antibiotics, to treat appendicitis caused due to infection. If, even after the completion of medication consumption, the symptoms of appendicitis don't subside, an individual must seek urgent medical attention. Usually, the treatment of appendicitis with medications is successful in the early stage and in an uncomplicated form of appendicitis with lower perforation of the abdomen.

Diagnosis:

• Preliminary Analysis

At first, the medical practitioners assess the severity and root cause of appendicitis through examination of the patient’s medical records. It involves asking for medical history involving any previous condition associated with the occurrence of symptoms.

It can also include digital rectal evaluation to check for tumours. Additionally, for female patients, the doctors conduct another assessment of the vagina, cervix and vulva to rule out pelvic inflammatory conditions.

• Blood Tests

Appendicitis is usually accompanied by a variety of infections. In fact, an abdominal infection or UTI can cause similar symptoms as appendicitis. To confirm the condition, doctors prescribe a complete blood count (CBC) test which analyses the signs of infection through the change in blood structure.

An increase in the white blood cell count directly indicates possible infection in the body. Moreover, the doctor can also recommend a C-reactive protein test to examine the presence of any autoimmune disorder.

• Urine Tests

Kidney stones can also have similar symptoms. On top of this, a urinary tract infection also causes similar signs. To ensure the presence of appendicitis, doctors recommend different tests involving urine examination to eliminate other diseases.

• Imaging Tests

After eliminating other possibilities, experts suggest scanning the abdomen to locate the affected area and the condition’s intensity. These tests include abdominal ultrasound, X-rays, MRI, and CT scan.

Through these methods, doctors identify potential reasons behind the symptoms, including faecal impaction, abscess, and inflammatory bowel disease other than appendicitis.

These examinations help in getting a detailed picture of the internal damage caused by appendicitis. Additionally, these also help in gaining a thorough chest analysis to rule out pneumonia.

MRI tests are generally recommended if a patient is pregnant. Undergoing these examinations might involve fasting for hours, depending upon the procedure and expert recommendation.

Treatment

• Antibiotics

Almost everyone will require antibiotics for appendicitis. Even if you did not have an infection to begin with, appendicitis usually causes one. Antibiotics are also a common preventive measure before surgery. If you have a very early and mild case of appendicitis, your doctor may advise you to wait and see if the condition improves on its own with antibiotics. You may prefer this method if you have risk factors that make surgery less safe for you. However, healthcare providers rarely recommend it because appendicitis often returns if the appendix is not removed. You may also need pain relievers. You can get this through your IV. If you are having surgery, you will be given general anaesthesia, which means you will not be conscious (awake) throughout the procedure.

The antibiotic medicines used to treat appendicitis:

• Cefotaxime 
• Piperacillin and Tazobactam
• Ampicillin and Sulbactam 
• Ceftriaxone 
• Cefepime 
• Gentamicin

• Meropenem 
   

  Needle Drainage

In the case of the detection of pus-filled sacs in the abdomen, the needle drainage method is utilised. Doctors use scanned images throughout the procedure to insert the needle into the abscess. Using the plunger, pus is extracted from the sacs. The fluid is later assessed to understand the antibiotics required post-surgery. Additionally, the patient is also prescribed intravenous antibiotics to treat the condition.

• Surgery

If there's a high likelihood of organ rupture and antibiotics fail to yield any results, doctors resort to appendectomy surgery. This procedure involves removing the appendix, a vestigial organ in the body. Generally, the surgeries are of two kinds: open and laparoscopic.

In the open appendectomy, incisions of 2-4 inches are made on the abdomen to remove the appendix. In contrast, laparoscopic appendectomy is a minimally invasive procedure where a digital device is inserted after a small incision to remove the appendix.

That being said, laparoscopic surgery is performed only on patients whose appendix hasn't ruptured. After the appendix burst, the infection spreads to other parts, which requires open surgery to clean the abdominal cavity.

Additional Information

• Symptoms of Peritonitis

Peritonitis is a condition that involves swelling and redness of the inner lining of the belly, called the peritoneum.

It can occur due to a hole in the belly lining or from an appendix rupture. Some other reasons which can cause peritonitis include a hole in the intestine, fluid infection due to end-stage renal diseases, liver cirrhosis, pelvic inflammatory disease and bacterial entry during surgery.

The signs of peritonitis vary from one individual to another. The general symptoms of the condition include:

• Severe belly ache worsening with motion 

• Fever

• Swollen belly

• Fluid in the stomach 

• Less urine than usual

• Extreme thirst 

• Nausea

• Vomiting and fever

• Low blood pressure 

• Difficulty breathing 

• Causes of Appendicitis

There is no precise cause of appendicitis. It gets triggered by inflammation owing to infection in the appendix leading to irritation and swelling in the region. The most commonly found causes leading to appendicitis comprise:

• Injury or trauma in the abdomen 

• Blockage at the meeting point of the appendix and intestines 

• Infection of the digestive tract 

• Inflammatory bowel diseases 

• Tumourous growth inside the appendix