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APPENDICITIS

Appendicitis is an inflammation of the appendix, a finger-like pouch present at the end of the colon on the lower side of the right abdomen. The appendix is considered as the vestigial organ as it has no function. Appendicitis can be acute of chronic; however, it is a medical emergency that requires immediate surgery. Anyone can develop appendicitis, but people between the ages 10 and 30 are most commonly affected. It is more common in males than in females. If the condition is left untreated, it may burst and cause infection. Therefore, immediate care is required.

Signs and Symptoms

Appendicitis usually starts as mild abdominal pain near the navel or upper abdomen which becomes severe as it moves to the lower right abdomen. The pain becomes worse while coughing, sneezing, or walking. The other common symptoms include:

  • Loss of appetite
  • Nausea and vomiting
  • Low-grade fever
  • Abdominal swelling
  • Constipation or diarrhea
  • Inability to pass gas
  • Diarrhea
  • Constipation

The patient may not have changes in bowel habits, but urination may be infected. If appendicitis occurs during pregnancy, the pain would be severe and if perforation occurs, the stomach becomes hard and swollen.

Causes

There is no exact cause of appendicitis. Researchers believe that it may be due to an obstruction in the appendix which is caused by the accumulation of fever, enlarged lymphoid follicles, worms, trauma, or tumors. The obstruction of the appendix causes accumulation of mucus and swelling leading to appendicitis. Often, a complete obstruction requires immediate surgical intervention. Peritonitis, an inflammation of the tissue lining the abdominal wall may also cause appendicitis.

Complications

When obstruction occurs in the appendix, bacteria invade the organ leading to the formation of pus and increased pressure. The increased pressure can compress local blood vessels decreasing blood flow that can result in gangrene. If the appendix ruptures, fecal matter enters the abdomen (medical emergency). A ruptured appendix can also cause inflammation of the abdominal wall (peritonitis). Inflammation of caecum or bladder may also occur due to ruptured appendix. If the appendix leaks out instead of rupturing, there will be the formation of an abscess.

Diagnosis

The doctor performs a physical examination to examine the tenderness in the lower quadrant of the abdomen. The pain may be higher in pregnant women and if there is a perforation, the stomach may become hard and swollen. If appendicitis is suspected, the doctor would recommend other tests such as:

  • Blood Tests – to rule out infections by observing white blood cell count
  • Urinalysis – to rule out urinary tract infection
  • Pelvic Exam – to rule out pelvic infections or any other gynecological problems that may be causing pain
  • Pregnancy Tests – to rule out suspected ectopic pregnancy
  • Imaging Tests – such as X-ray, ultrasound, or CT scan to observe other sources of abdominal pain and also to determine complications
  • Chest X-Ray – to rule out right lower lobe pneumonia (have similar symptoms like appendicitis)

Treatment

The treatment options vary with the severity of the patient condition. Surgery is the most preferred option.

Surgery

The standard treatment for appendicitis is surgery that involves removal of the appendix. The procedure is called appendectomy that can be done in two methods. The type of surgery performed varies for every individual depending on the physical condition.

  • Laparotomy – a single incision is made to remove the appendix
  • Laparoscopic Surgery – several small incisions are made using special surgical tools to remove the appendix. The advantage of this surgery is a fast recovery

If there is an abscess without rupture, the doctors prescribes antibiotics and then drains the abscess. After draining, surgery is performed to remove the appendix. If the abscess or appendix is ruptured, then the patient may need surgery immediately. In this case, the surgeon may prefer open appendectomy as this procedure facilitates cleaning of the abdominal cavity.

Aftercare: The patient should follow few measures for a quick recovery after the surgery.

  • Limit physical activity for three to five days. In the case of open appendectomy, limit activity for 10 to 14 days
  • Supporting the abdomen while coughing by placing a pillow over the abdomen to reduce pain
  • Take adequate rest
  • Seek medical advice if pain persists for a prolonged time

Nonsurgical therapy

If the patient is not healthy enough to undergo surgery, the doctor would recommend nonsurgical treatment. This therapy includes the use of antibiotics to treat infections and consumption of a soft diet that includes foods rich in fiber and healthy fruits, and vegetables.

Prevention

One cannot prevent appendicitis but following certain precautions can lower the risk:<

  • Taking fiber-rich diet such as oat bran or wheat germ, taking brown rice, fresh fruits and vegetables
  • Drinking lots of water
  • Taking small meals many times a day
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