You must've heard instances of people who have experienced stomach pain in the evening and were operated for appendicitis the next morning. And you might have wondered: what happened suddenly? It is not unusual for such instances to occur. Sudden pain is a hallmark of this condition.
What is appendicitis?
Appendicitis is a painful swelling and infection of the appendix. The appendix is a finger-like pouch attached to the large intestine and located in the lower right area of the abdomen. Scientists are not sure what the appendix does, if anything, but removing it does not appear to affect a person's health. The inside of the appendix is called the appendiceal lumen. Mucus created by the appendix travels through the appendiceal lumen and empties into the large intestine. Doctors generally opt for a surgery once appendicitis is diagnosed to prevent infection as the appendix might burst.
What causes it?
Obstruction of the appendiceal lumen causes appendicitis. Mucus backs up in the appendiceal lumen, causing bacteria that normally live inside the appendix to multiply. As a result, the appendix swells and becomes infected. Sources of obstruction include:
- Faeces, parasites, or growths that clog the appendiceal lumen
- Enlarged lymph tissue in the wall of the appendix, caused by infection in the gastrointestinal tract or elsewhere in the body
- Inflammatory bowel disease, including Crohn's disease and ulcerative colitis
- Trauma to the abdomen.
An inflamed appendix is likely to burst if not removed. Bursting spreads infection throughout the abdomen causing a potentially dangerous condition called peritonitis.
Who is at risk?
Although anyone can get appendicitis, it is more common among people between 10 and 30 years of age. It leads to more emergency abdominal surgeries than any other cause.
What are the symptoms?
Most people with appendicitis have classic symptoms that a doctor can easily identify. The main symptom of appendicitis is abdominal pain.
The abdominal pain usually:
- occurs suddenly, often causing a person to wake up at night
- occurs before any other symptoms
- begins near the belly button and then moves lower and to the right
- is new and unlike any pain felt before
- gets worse in a matter of hours
- gets worse when moving around, taking deep breaths, coughing, or sneezing.
Other symptoms may include:
- Loss of appetite
- Constipation or diarrhoea
- Inability to pass gas
- A low-grade fever that follows other symptoms
- Abdominal swelling
- The feeling that passing stool will relieve discomfort.
How is it diagnosed?
The doctor mainly uses the details you give about your abdominal pain to diagnose appendicitis. He also assesses pain by touching or applying pressure to specific areas of the abdomen.
Guarding: This occurs when a person subconsciously tenses the abdominal muscles during an examination. Voluntary guarding occurs the moment the doctor's hand touches the abdomen. Involuntary guarding occurs before the doctor actually makes contact.
Rebound tenderness: A doctor tests for rebound tenderness by applying hand pressure to a patient's abdomen and then letting go. Pain felt upon the release of the pressure indicates rebound tenderness. A person may also experience rebound tenderness as pain when the abdomen is jarred—for example, when a person bumps into something or goes over a bump in a car.
Rovsing's sign: A doctor tests for this by applying hand pressure to the lower left side of the abdomen. Pain felt on the lower right side of the abdomen upon the release of pressure on the left side indicates the presence of Rovsing's sign.
Psoas sign: The right psoas muscle runs over the pelvis near the appendix. Flexing this muscle will cause abdominal pain if the appendix is inflamed. A doctor can check for the psoas sign by applying resistance to the right knee as the patient tries to lift the right thigh while lying down.
Obturator sign: The right obturator muscle also runs near the appendix. The doctor tests for the obturator sign by asking the patient to lie down with the right leg bent at the knee. Moving the bent knee left and right requires flexing the obturator muscle and will cause abdominal pain if the appendix is inflamed. Women of childbearing age may be asked to undergo a pelvic exam to rule out gynaecological conditions, which sometimes cause abdominal pain similar to that in appendicitis.
Blood tests are used to check for signs of infection, such as a high white blood cell count. Blood tests may also show dehydration or fluid and electrolyte imbalances. Urinalysis is used to rule out a urinary tract infection. Doctors may also order a pregnancy test for women.
How is it treated?
Typically, appendicitis is treated by removing the appendix. If appendicitis is suspected, a doctor will often suggest surgery without conducting extensive diagnostic testing. Prompt surgery decreases the possibility of the appendix bursting. Surgery to remove it is called appendectomy and can be done two ways. The older method, called laparotomy, removes the appendix through a single incision in the lower right area of the abdomen.
The newer method, called laparoscopic surgery, uses several smaller incisions and special surgical tools fed through the incisions to remove the appendix. Laparoscopic surgery leads to fewer complications and has a shorter recovery time.
Non-surgical treatment may be used if surgery is not available—if a person is not well enough to undergo surgery, or if the diagnosis is unclear. Research suggests that appendicitis can get better without surgery. Non-surgical treatment includes antibiotics to treat infection and a liquid or soft diet until the infection subsides. A soft diet is low in fibre and easily breaks down in the gastrointestinal tract.
What does recovery involve?
With adequate care, most people recover from appendicitis and do not need to make changes to diet, exercise, or lifestyle. Full recovery from surgery takes about 4 – 6 weeks. Limiting physical activity during this time allows tissues to heal.
Lastly, remember that appendicitis requires immediate care. People who think they have appendicitis should see a doctor right away.
Courtesy: The National Digestive Diseases Information Clearinghouse [NDDIC]. NDDIC is a service of the National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], part of the National Institutes of Health of the U.S. Department of Health and Human Services. Website: www.digestive.niddk.nih.gov
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