Causes, symptoms and treatment of Appendicitis

Appendicitis: Causes, Symptoms and Treatments

 Appendicitis is a condition in which the appendix becomes swollen, inflamed, and filled with pus. The appendix is a small pouch shaped like a small finger. It is on the right side of the abdomen, connected to the colon.

Experts are not sure what the appendix is for. Charles Darwin wondered whether it might have been an organ our ancestors used to digest plants. Recent studies indicate that the appendix may be a dedicated environment for friendly bacteria which facilitate digestion and fight infection.

Appendicitis generally affects people aged between 10 and 30, but it can strike at any age. Approximately 250,000 appendectomies are performed in the United States each year to treat appendicitis.

Anatomy of the appendix and large intestine

The appendix is a thin, tube-shaped sac measuring about four inches long. It is normally situated on the right side of the abdomen and opens into the lower part of the large intestine.

What causes appendicitis?

Experts believe there are two likely causes of appendicitis:

• Infection - a stomach infection may have found its way to the appendix.
• Obstruction - a hard piece of stool may have got trapped in the appendix. The bacteria in the trapped stool may then have infected the appendix.

Symptoms of appendicitis

Initially, some pain can be felt anywhere in the stomach area, but later, as it intensifies, its location becomes more defined in the lower right-hand side of the abdomen - an area known as McBurney point.

The following symptoms are common:

If you experience a progressively worsening pain in your abdomen then you should seek medical attention.

• Progressively worsening pain
• Coughing or sneezing is painful
• Nausea
• Vomiting
• Diarrhea
• Inability to pass gas (break wind, fart)
• Fever
• Constipation
• Loss of appetite.

Anybody who experiences a progressively worsening pain in the abdomen should seek medical attention. Other conditions may have similar symptoms, such as urinary tract infection; even so, they all require urgent medical attention.

Diagnosing appendicitis

Diagnosing appendicitis can be challenging. Half of all patients who have appendicitis do not have typical symptoms - the pain may be located in different parts of the body. Other conditions may have very similar symptoms, such as gastroenteritis,urinary tract infection, ectopic pregnancy, Crohn's disease, or a kidney stone.

Not everybody has their appendix in exactly the same place - some are located behind the colon, behind the liver, or in the pelvis.

A GP (general practitioner, primary care physician) will examine the patient and ask some questions related to symptoms. He/she will apply pressure to the area to see if it worsens the pain.

If typical appendicitis signs and symptoms are detected, the GP will diagnose appendicitis. If they are not, further tests will be ordered. Tests may include:

• A blood test - to determine whether there is an infection.
• A urine test - this will identify a kidney or bladder infection. Researchers at the Proteomics Center at Children's Hospital Boston, USA, demonstrated that a protein detectable in urine might serve as a biomarker for appendicitis.
• An MRI, CT or ultrasound scan - to view a 3-D image of the appendix and see whether it is inflamed (swollen). Color Doppler ultrasound, not CT, should be the first imaging examination for adult patients with suspected acute appendicitis, say researchers at Rambam Health Care Campus in Haifa, Israel.

Sometimes a decision will be made to surgically remove the appendix because it is too risky to wait around for the tests to confirm the diagnosis.

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Recent developments on appendicitis from MNT news

Appendicitis: 'antibiotics are an alternative to surgery'

A randomized controlled trial has brought into question the established medical doctrine that appendicitis should be treated by surgical removal, finding that a level of success can alternatively be achieved by use of antibiotics.

Treatments for appendicitis

Doctors may decide to treat the patient with antibiotics. This is rare and the infection would need to be very mild. In most cases an appendectomy will be performed - the appendix will be surgically removed.

• Laparoscopy (keyhole surgery) 
  
  Laparoscopic surgery is also known as minimally invasive surgery (MIS), bandaid surgery, or keyhole surgery. The surgeon inserts a very thin tube (laparoscope), which has a tiny video camera and its own lighting, into the abdomen through a cannula. A cannula is a hollow instrument.
  
  Thanks to the tiny video camera, the surgeon can view the insides of the abdomen with magnification on a monitor. Tiny instruments respond to the movements of the surgeon's hands and the appendix is removed through small abdominal incisions.
  
  Thanks to the precision of the operation, minimal loss of blood, and the need for very small incisions, the patient recovers much faster and with less scarring, compared to traditional open surgery. In most cases it is no longer necessary to open the patient up with a large incision.
  
  However, a report in the Journal of the American College of Surgeons suggests that a traditional, open appendectomy may be preferable to a less-invasive laparoscopic appendectomy for most patients with acute appendicitis, contrary to recent trends. Apparently, laparoscopic surgery increases costs and may raise the risk of complications in the majority of appendectomy patients.


• Sometimes traditional surgery is necessary
  
  If the appendix has ruptured and infection has spread, or if there is an abscess, a larger incision will be made so that the area inside the abdominal cavity can be cleaned.
  
  Traditional appendectomy is also used if the patient has tumors in the digestive system, if a woman is in her third trimester of pregnancy, or if the patient had many abdominals surgeries before.
  
  After the operation the patient will be given antibiotics intravenously.


• Delaying surgery
  
  If the patient has had symptoms for at least five days the doctor may recommend a course of antibiotics in order to shrink the appendix and clear up surrounding infection, and perform surgery later.
  
  Researchers from the Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, England, explained thatsurgery does not have to be the first line of treatment for acute uncomplicated appendicitis - antibiotics may be a safe and viable alternative. They published their study in the BMJ (April 2012 issue).
  
  Scientists from Assistance Publique-Hôpitaux de Paris and Université Paris XI, Paris, France, disagreed. They wrote in The Lancet (May 2011 issue) that surgery for appendicitis much more effective than antibiotics.
  
  If there is an abscess the doctor may decide to drain it first and operate at a later date.

Possible complications of appendicitis

• Peritonitis
  
  If the appendix ruptures and releases the infection into the abdomen the patient may develop peritonitis. The peritoneum will become inflamed. The peritoneum is the membrane that lines the abdominal cavity and covers most of the abdominal organs. Peritonitis causes the bowels to shut down - bowel movements will stop and the bowel will become blocked. The patient will develop a fever and could go into shock. Peritonitis requires urgent treatment.


• Abscess
  
  If the infection seeps out of the appendix and mixes with intestinal contents, it may form an abscess. If the abscess is not treated it can cause peritonitis. Sometimes abscesses are treated with antibiotics. Often they are surgically drained with the aid of a tube which is placed into the abdomen.

Appendicitis prevention

Countries with lower incidences of appendicitis also tend to have more fiber in their people'sDIETS, compared to other countries. It would therefore be logical to assume that a high fiber diet may help reduce your chances of developing appendicitis. One theory is that with a high fiber diet the resulting softer stools are less likely to get trapped in the appendix.