Appendicitis is a condition that affects the appendix, a small tube sized organ attached to the lower side of the large intestine. A person is said to have appendicitis when their appendix is inflamed. The inflammation of the appendix is believed to be caused by the appendix getting blocked. Although the exact reason for the blockage is not known, it is speculated that it is caused often by stool, a foreign body, or cancer. Traumatic injury is also known to be a cause of Appendicitis. There are numerous studies to determine the exact function of the appendix, some suggest it plays a role in immunity of the gut, but this is not certain. More importantly, the appendix can be removed and a person can function normally, with no noticeable difference. Appendicitis can be recognised by a considerable pain in the lower part of the abdomen along with nausea and vomiting. Appendicitis requires immediate care; other symptoms of Appendicitis include:
- Mild cramping in the abdomen that progresses into more severe abdominal pain.
- Fever
- Loss of appetite
- Nausea
- Diarrhoea or Constipation
- Inability to pass gas
If the Appendix is left untreated, it can develop into a life-threatening situation. The first thing that might occur when left untreated, is the bursting or perforation of the Appendix. In the case where the appendix bursts, infectious bacteria spills on the inside of the abdomen. This can cause a condition known as peritonitis. Peritonitis is an inflammation of the lining of the abdominal cavity, known as the peritoneum. This bacterial infection, if left untreated, can spread throughout the body, which may cause long term damage or even be fatal.
An alternate possibility if the appendix is ruptured, is the formation of an abscess. This is a pus filled infectious sac that is walled off from the body. The explosion of this abscess would also lead to peritonitis. Due to these reasons, once Appendicitis is diagnosed, it is considered a medical emergency. At Apollo Cradle Jubilee Hills, medical professionals are available round the clock for emergencies like appendicitis, and state of the art equipment ensures the best recovery.
Doctors may conduct a variety of tests to confirm whether Appendicitis is the source of the pain. Often, patients will only display a few of the symptoms and doctors may conduct have to conduct multiple tests in order to confirm the source of the pain. These include:
- Medical History: The medical professional may inquire about your past medical conditions, any previous illnesses or surgeries. They may also require details about medicines, alcohol or drugs consumed.
- Physical exam: The medical professional may require specific details about the location of the pain and when the pain began. A physical exam involves applying pressure or touching specific areas of the abdomen in order to inhibit certain responses.
- Blood tests: If blood test result show high white blood cell count, this often indicates an infection. Dehydration may also appear on a blood test.
- Urine test: This can help rule out the possibility of other conditions, such as urinary tract infection or a kidney stone (another common cause of abdominal pain).
- Imaging tests: Doctors may conduct an ultrasound, MRI or CT scan depending on the requirements. This gives them a clear image of the Appendix and the physician to properly diagnose the patient.
- Pregnancy test: In the case of women, health care professionals may require a blood or urine sample to check if the woman is pregnant.
Once properly diagnosed, the only way to treat Appendicitis is through the surgical removal of the Appendix from the body known as an Appendectomy. The patient may have to restrain from eating or drinking for certain duration specified by the doctor, prior to the surgery. The patient may have more requirements, depending on their medical history, which can be judged by the doctor at the time. There are two types of appendectomy which are detailed below:
- Open Appendectomy: Like all open surgeries, open appendectomy involves making a single large incision in the abdomen. Instruments are then used to hold this open and operate on the appendix. The appendix is extracted from the body. In the cases where the appendix has burst, open appendectomy is used in preference to Laparoscopic appendectomy as the infection has to be cleared entirely from the abdomen.
- Laparoscopic Appendectomy: The difference between Laparoscopic and Open appendectomy is that laparoscopic provides a less invasive and faster recovery method of surgical procedure. In cases where the appendix has not burst, Laparoscopic appendectomy allows patients to spend less time in the hospital for recovery. Surgically, the difference being that laparoscopic appendectomy involves making several smaller incisions into the abdomen first. Then a laparoscope, a fibre optic cable with a small camera attached to the end, is inserted into one of the incisions. Surgical instruments are inserted in the other incisions. The surgeon uses the video feed to manipulate the surgical instruments and remove the appendix from the body.
Unlike most other surgical operations in terms of providing an upper hand, Laparoscopic only gives the patient a faster recovery time and a less invasive procedure. In terms of the success of the procedure, both open and laparoscopic surgeries are equally successful. In fact, open appendectomy is preferred in cases where the appendix has ruptured, the larger incision gives the surgeon more room to operate and analyse the inside of the abdomen.
Like any surgery, there are certain complications that could occur during the process of Appendectomy.
- Bleeding (haemorrhage)
- Infection through wound
- Bursting of the appendix during surgery
- Injury to internal organs
Before the surgery, a patient may have to fast for up to 8 hours before the surgery, if it is not severe.
- The patient is asked to remove their clothing and accessories and change into a hospital gown.
- An IV will be inserted in your arm.
- Once the patient is resting on the operating table, local or general anaesthetic is given to sedate the patient or numb the area.
- The area where the incision has to be made may have to be shaved or trimmed.
Once the surgical procedure is complete, the appendix is sent for lab testing. The patient may have to remain in the hospital or recovery room for a certain period of time, this depends on the type of surgery. As a general or local Anaesthetic, will have been given to the patient, the patient may require somebody to drive or accompany them home.
Once properly diagnosed the only way to treat Appendicitis is through the surgical removal of the Appendix from the body- known as an Appendectomy. The patient may have to restrain from eating or drinking for certain duration specified by the doctor prior to the surgery. The patient may have more requirements depending on their medical history, which can be judged at the doctor at the time. The doctor might use Open appendectomy, which involves a large cut across the abdomen in order to extract the appendix. Or laparoscopic, in which several smaller cuts are made and a camera is inserted inside. The Appendix is then surgically removed. Laparoscopic appendectomy patients can usually leave the hospital the next morning, Open appendectomy patients may take more time to fully recover due to the size of the incision.
There is no way to prevent appendicitis, but a diet higher in fruits and vegetables lowers the chances of Appendicitis. Post the surgery it is advisable, especially for patients who have undergone open appendectomy to ensure they get proper rest. The patient may experience constipation, bruising, and pain. The patient may need a recovery time of 2 weeks to come back to the normal activities. In case of any sign of infection post-surgery, patients must contact the doctor. Patient can experience below signs post-surgery –
- Swelling and worsened pain
- Vomiting repeatedly
- High temperature
- Pus or other discharge at the site of the operation
It is advised to have high-fiber diet that reduces the chances of developing appendicitis as the softer stools are less likely to get trapped in the appendix. There are home remedies that could help to heal the body after the surgery. This includes:
- Take proper rest as it helps the body to heal.
- When you cough, support your abdomen with a pillow as coughing can apply pressure. Placing a pillow over abdomen can help to reduce pain while coughing, laughing or moving.
- If the medicines are not working in reducing the pain, consult the doctor. Pain and stress on the body can slow down the process of healing, hence it is important to intake proper medicines.
- Avoid stressful activity for around 3 to 5 days after the surgery.
Appendicitis is rare to occur for infants and usually affects kids and teens who are between 5 to 20 years of age. Prior to the surgery antibiotics are recommended by the doctors. For patients suffering from mild degree of inflammation and less complication, antibiotics alone are sufficient. Confined appendicitis is referred when the patient’s body is able to contain the inflammation and infection as well as resolve it. The inflammation and infection are mild and is localized within a small area of the body which is usually improved within few days of observation. The appendix is removed later on if any complication occurs.
There are various other conditions that might mimic appendicitis that may include:
- Meckel’s diverticulitis that can be located in the right lower abdomen near the appendix. If it is perforated or inflamed, it can be removed surgically
- Pelvic inflammatory disease (PID) that is located near the fallopian tube and ovary. Surgery is not needed to remove if antibiotic therapy works on it.
- Kidney diseases can mimic appendicitis and cause inflammatory problems near the appendix.
- Ectopic pregnancy can mimic appendicitis and can occur if the fetus is implanted in the fallopian tube or somewhere else instead of uterus.
The patient can consult the family doctor or general practitioner if they suffer from any abdominal pain. The patient will be hospitalized if the appendix is detected and surgery can be performed to remove it. Before the surgery, the doctors will recommend antibiotics and alternative treatments that can be used as medications and to avoid and control pain. The patient can ask the doctors for safe options such as distracting activities to take the pain off the mind. It is recommended to ask questions to the doctors to clear the doubt about the appendicitis surgery. The patient should seek medical attention on time to avoid further complications as timely diagnosis is very important.
