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Appendicitis

Overview

Appendicitis is the medical term used for the inflammation of the appendix. The appendix is a small tube-like organ present as a part of your digestive tract. It does not serve any major function; therefore, it is often assumed as a vestigial organ. Despite that, any infective or non-infective cause that disturbs the appendix can lead to appendicitis. The pain resulting from appendicitis can be quite severe and requires emergency medical treatment to relieve it. This is one of the reasons why appendicitis is one of the most common causes of abdominal surgeries.

Causes

The major factor associated with appendicitis is obstruction of the appendix. Obstruction due to any cause reduces the blood flow towards the appendix. As the cells of the appendix start to die, bacteria from your digestive tract leak outside in the abdominal cavity, which can cause severe complications, even death. Obstruction of the appendix can be caused by a foreign body such as bezoars, constipation, traumatic injury, appendix stones, intestinal worms, swollen lymph nodes, or tumors. In a few cases of pregnancy, the excessive pressure within the abdominal cavity due to fetal growth may also obstruct the appendix and cause it to burst open.

Types

Appendicitis can be categorized into two types: acute appendicitis and chronic appendicitis.
Acute appendicitis is the most frequent type and is a major cause of emergency abdominal surgery. It occurs due to obstruction of the appendix and can lead to rupture if not treated immediately. This condition is commonly termed as burst appendix and can be a serious life-threatening condition if it causes peritonitis or sepsis.
Chronic appendicitis is the less common type and is usually preceded by acute appendicitis. It may occur in people who didn’t have their appendix removed at the time of acute appendicitis. The symptoms of this type are comparatively less severe, but it still requires medical attention.

Risk Factors And Epidemiology

Risk factors for appendicitis are linked with its causes. Prolonged retention of feces in your large intestines can obstruct the appendix. That’s why constipation due to physiological or anatomical causes is considered a significant risk factor for appendicitis. A family history of appendicitis can also increase its risk of development, especially in children. Few other risk factors for appendicitis include diabetes, cystic fibrosis, chronic obstructive pulmonary disease, excessive use of steroids, etc.
Appendicitis may occur at any age, but it is more prevalent among individuals ranging from 10 to 30 years old. Research has also indicated that appendicitis occurs more frequently in men than women.

Signs And Symptoms

The most frequent symptom of appendicitis is a pain in the lower right quadrant of your abdomen. This often begins as a mild pain on the right side of the abdomen, which travels lower as it gets worse. This pain keeps increasing in severity and gets worse while coughing. The pain of appendicitis is localized and usually different from other types of abdominal pain. The affected abdomen region can become tender when pressure is applied. Other associated symptoms may include nausea, vomiting, lack of appetite, and fever. You may also experience diarrhea, bloating, or difficulty during defecation in a few cases.

Diagnosis

The first step towards a diagnosis of appendicitis is acquiring a history of presenting symptoms such as onset, duration, severity, etc., followed by a clinical examination of the abdomen. The affected person’s abdomen is palpated, and clinical signs such as tenderness or rigidity are noticed. Digital rectal examination may be performed to support the diagnosis. A blood sample is taken for complete blood count (CBC), showing an increased number of white blood cells (WBCs) and other signs of infection. Urinalysis may also be done to rule out pregnancy or other abdomen infections. The preferred radiographic imaging technique for the diagnosis of appendicitis is abdominal ultrasound. A CT scan or MRI may follow this if ultrasound is not clear enough to make an accurate diagnosis.

Differential Diagnosis

The symptoms of appendicitis can be confused with other abdominal diseases. It is important to differentiate appendicitis from other conditions such as inflammatory bowel disease, diverticulitis, strangulated hernia, colon cancer, cystitis, prostatitis, endometritis, acute cholangitis, acute pancreatitis, acute cholecystitis, kidney stone, ectopic pregnancy, etc.

Treatment

The preferred treatment option for acute appendicitis is the surgical removal of the appendix. This can be performed by open appendectomy or laparoscopic appendectomy. Open appendectomy involves the removal of the appendix by a large incision in the right abdominal area. Laparoscopic appendectomy involves smaller incisions for laparoscopic instruments to remove the inflamed appendix. Both treatment options are satisfactory, but these surgical options depend on the doctor and patient. In severe cases of infection, antibiotics are given orally or intravenously to reduce symptoms. Bed rest is suggested, and any strenuous activity should be avoided before the surgery as it may rupture the appendix. Dietary regulations are also advised before administration of general anesthesia.

Medication

Antipyretics or analgesics such as acetaminophen, diclofenac, etc., may be prescribed to reduce fever and pain. Antibiotics such as cefoxitin, levofloxacin, metronidazole, etc., are only prescribed in case of a severe infection or patients with a compromised immune system.

Prognosis

Appendicitis can be treated well with surgery, and a majority of the patients recover completely afterward. The recovery period may vary depending on the age and health of the patient. In most cases, recovery is faster after laparoscopic appendectomy than open appendectomy. Complications such as peritonitis, abscess, or sepsis may develop with untreated appendicitis.

Prevention

There are no specific methods for preventing appendicitis since it can occur spontaneously without any apparent cause. However, it is recommended to increase intake of a high fiber diet and drink plenty of water to avoid constipation which can be a preceding factor for appendicitis. A high-fiber diet includes fresh fruits, vegetables, whole wheat, bran, brown rice, oatmeal, kidney beans, etc. If you have a complaint of chronic constipation, it is best to get it checked by a doctor and take prescribed supplements to avoid the risk of appendicitis.