Appendix is a narrow organ, which is shaped like a human finger. On the right side of the abdomen, the appendix branches off the first segment of the large intestine. Sudden inflammation of the appendix is known as Acute Appendicitis. Appendix is a vestigial organ and has no known function; however it can cause problems by becoming diseased like any other vital organ. Acute appendicitis is the commonest cause behind abdominal surgery in the whole world.
Acute appendicitis, if not treated immediately, can burst and spill out the fecal matter into the abdominal cavity resulting in peritonitis, which is a potentially life-threatening infection. This infection can also be closed off and turn into an abscess.
Acute appendicitis commonly is seen in individuals between the age group of 20-30; however, it can occur at any age. Acute appendicitis is not that common in older individuals and the presentation of the symptoms is usually mild, which leads to delayed diagnosis of the acute episode. For this reason older individuals are at an increased risk for rupture with either peritonitis or abscess formation.
Causes of Acute Appendicitis
- The exact cause of appendicitis is not known.
- Acute appendicitis is commonly caused by obstruction of the intestinal lumen leading to invasion by the gut flora into the wall of the appendix.
- Bacterial infection is also one of the common causes of Acute Appendicitis.
- There may be obstruction in the appendix due to a lump of the feces, fecaliths (fecal debris), calcium salts and tumors (rarely). All these factors can lead to inflammation and infection.
- Inflammation and swelling in the appendix leads to infection, formation of blood clot and can also lead to rupture of the appendix.
- Lymphoid hyperplasia is a condition, which occurs with infectious and inflammatory medical conditions, such as Crohn's disease, amebiasis, measles, gastroenteritis, mononucleosis and respiratory infections. This can lead to acute appendicitis.
Signs & Symptoms of Acute Appendicitis
Very young children or older individuals aged above 65 may have a very deceptively mild presentation of the symptoms of acute appendicitis. Otherwise, different people have varied symptoms of acute appendicitis and they include:
- In the early stages, patient can have vague tenderness or discomfort near the navel region which can migrate to the right lower quadrant of the abdomen.
- One of the symptoms of acute appendicitis is that Patient experiences localized sharp and constant pain in a few hours.
- Pain increases with any movement, deep breathing, sneezing, coughing, and walking or if anyone touches the affected region.
- Patient has low grade fever, which is below 102°F.
- If the patient has high fever with chills, then it can be an indication of an abscessed appendix.
- Patient has fast or rapid heartbeat.
- In later stages, patient has swelling in the abdomen.
- In some cases, patient can also have nausea and vomiting.
- There may be loss of appetite.
- Patient can also have bad breath and a coated tongue.
- There may be frequent and/or painful urination.
- Patent can have blood in the urine (hematuria).
- Patient, and especially infants, will have abdominal bloating or swelling.
- Sudden cessation of the abdominal pain after the above symptoms is an indication of ruptured appendix which is a medical emergency.
Investigations to Diagnose Acute Appendicitis
- Medical history and physical examination is done to exclude other medical conditions, which produce symptoms resembling appendicitis.
- A rectal examination can also be done.
- Blood and urine tests are done.
- CT (computed tomography) scan or an x-ray of the abdomen is done to confirm the diagnosis.
- Magnetic Resonance Imaging (MRI) is also a reliable method for detecting acute appendicitis.
- Ultrasound is commonly done in children, as it does not generate harmful radiation thus is more safe.
Treatment of Acute Appendicitis
- If the patient experiences any of the above mentioned symptoms, then it is imperative to call the doctor immediately.
- If the patient's symptoms are vague and not definitive, then the temperature must be taken every two hours and noted down for the doctor to see.
- Laparoscopic Appendectomy is a surgical procedure where the appendix is removed via a small incision using a special instrument known as laparoscope. Surgery should be done immediately and should not be delayed for more than a few hours. Laparoscopic appendectomy involves minimal scarring and has quicker recovery time than the traditional appendectomy.
- If there is formation of an abscess, then the surgery can be performed at a later date and the doctor will drain the abscess and prescribe antibiotics.
Prevention of Acute Appendicitis
There is a popular belief that swallowing fruit seeds causes or leads to appendicitis. However, this is not true and there are no definite preventive measures.