What is Appendicitis?
Appendicitis is a severe medical condition characterized by inflammation of the appendix–a small pouch-like structure attached to the large intestine. Usually, appendicitis results from a blockage in the opening of the appendix.
Various interdisciplinary Appendicitis treatments that best suit a patient’s symptoms are recommended, depending on the severity of the condition.
Appendix, large intestine
What causes Appendicitis?
The exact cause of appendicitis is not known; however, it is believed to be caused by the following:
- Blockage: Usually, appendicitis is caused by the blockage of the appendix due to hardened feces, foreign objects, injuries, swollen lymph nodes, intestinal worms, a cancerous growth, etc.
- Infection: Infections such as bacterial infection or protozoal infection could also lead to swelling of the appendix and pus formation.
What are the signs or symptoms of appendicitis?
Signs and symptoms of appendicitis include:
- Abdominal pain that begins suddenly and worsens with cough or movement
- Pain that moves to the lower right side of the abdomen
- Swelling in the abdominal area
- Appetite loss
- Fever (usually low-grade)
- Unable to pass gas
- Difficult or painful urination
- Abdominal cramps
What is the possible Appendicitis Treatment
In most cases, surgery is the only and most appropriate Appendicitis treatment option. The doctor removes the appendix from your body during surgery, and the procedure is known as appendectomy.
Additional Appendicitis treatment options include using antibiotics, IV fluids, painkillers, and drainage of pus using a needle or surgical interventions, depending upon the stage and severity of the condition.
Doctors also prescribe antibiotics to resolve the infection and appendicitis in a rare mild appendicitis case.
What are the risk factors of appendicitis?
Risk factors for appendicitis include the following:
- Age: People between 10 and to 30-years of age are most likely to develop appendicitis.
- Sex: Men are at more risk of developing appendicitis compared to women.
- Family history: People with a familial history of appendicitis are more likely to develop the condition.
- Injury or trauma: Any injury or trauma to the intestinal area can increase the risk of blockage and infections causing appendicitis.
- Cancers: People with intestinal cancer are more likely to develop blockage and appendicitis.
What are the different stages of appendicitis?
The various stages of appendicitis are as follows:
- Early-stage appendicitis: Characterized by appendiceal lumen obstruction leading to edema, ulceration, and bacterial diapedesis.
- Suppurative appendicitis: Increased intraluminal pressure leads to bacterial invasion of the appendiceal wall and inflammatory fluid build-up.
- Gangrenous appendicitis: Characterized by intramural arterial/venous thrombosis.
- Perforated appendicitis: Characterized by perforation (localized or generalized) due to persistent tissue ischemia.
- Phlegmonous appendicitis: Characterized by focal abscess formation due to perforated appendix.
- Chronic appendicitis: Characterized by chronic active swelling of the appendix wall leading to pain continuing for 3 weeks.
What is the typical test to confirm appendicitis?
Typical test to confirm appendicitis starts with a physical examination by a doctor assessing the painful area and rigidity and a few questions regarding the history, pain severity, and other symptoms.
Next, doctors recommend blood tests to check for any signs of infection by looking at the blood cell counts. Additionally, your doctor may recommend undergoing a urine test to rule out urinary tract infections or kidney stones.
Finally, after ruling out the most differential diagnosis (details below), the doctor confirms appendicitis using imaging tests such as abdominal ultrasound, abdominal X-ray, CT scan, or Magnetic resonance imaging (MRI) for assessment of the affected area and cause of obstruction.
What is the primary prevention of appendicitis?
Although nothing much can be done to prevent appendicitis (since the cause isn’t concretely known); however, a few lifestyle modifications can be adopted to reduce the risk of developing appendicitis:
- Whole-grain foods: Add more whole-grain foods /flours such as wheat, oat bran, barley, etc., to your diet to increase your daily fiber intake.
- Fruits and veggies: Add fruit and vegetable salads in your meals or at snack times to increase roughage to keep your stools soft and reduce the risk of obstruction.
- Add legumes, lentils, and beans to your diet to increase fiber content.
What is the secondary prevention of appendicitis?
Secondary prevention aims to prevent the recurrence of the disease or the onset of complications. For example, after your appendix surgery, you can take the following steps:
- Avoid strenuous activity: Don’t indulge in strenuous activities for at least a few weeks following the surgery. This will help in quick recovery.
- Add fiber to your diet: Add fibrous foods to keep your stools soft and moving.
- Support your abdomen while coughing to avoid excess pressure and associated pain.
- Look for red flags: Always keep an eye on any complications and seek medical care accordingly and immediately.
- Regular follow-ups: Follow-up with your doctor per the schedule to ensure a quick recovery and proper healing. It would be best to discuss this before getting back to work or school with your doctor as you return to your regular routine.
What is the alternate name of appendicitis?
The alternative name for appendicitis is Epityphlitis.
What is the differential diagnosis of appendicitis?
The clinical symptoms of appendicitis may mimic various diseases such as:
- Kidney stones
- Colon cancer
- Pelvic inflammatory disease
- Urinary tract infection
- Renal colic
- Bacterial enteritis
- Rectus sheath hematoma
- Crohn disease
- Perforated duodenal ulcer
- Mesenteric ischemia
- Ovarian cyst, etc.
So, differential diagnosis is essential to rule out any other inflammatory conditions that could share the same symptoms as appendicitis.
Epidemiology of appendicitis
These are some epidemiological data on the condition:
- Appendicitis is among the most common causes of abdominal pain and emergency surgeries.
- Adult men are at a 1.4 times higher risk of developing appendicitis than women.
- Asians and Africans have less reported appendicitis due to dietary habits focusing on fiber inclusion.
- Appendicitis is more common from 10 to 30 years of age.
What is the expected prognosis of appendicitis?
The prognosis depends on the stage of appendicitis and the time of surgical intervention. People undergoing early surgery respond very well with minimal complications and almost no impact on quality of life or life expectancy.
Natural Progression of appendicitis
The progression of appendicitis is typically rapid. Pain will start following the inflammation of the appendix and will worsen with time and move to the right lower quadrant within hours. The untreated condition will lead to the bursting of the appendix and subsequent infections.
Pathophysiology of appendicitis
Obstruction of the appendix lumen (opening) by lymphoid hyperplasia, hardened stool, intestinal worms, or foreign bodies leads to appendicitis. This obstruction further causes inflammation, infection, ischemia, bacterial growth, abscess formation, and appendiceal distention.
Untreated appendicitis can further progress to perforation, necrosis of tissue, gangrene, sepsis, and super-infections.
What are the possible complications of appendicitis?
If left untreated, serious complications can occur from this condition. For example, the appendix can burst within 48-72 hours, spilling debris, stool, pus, and other contents into the abdomen.
This spillage could lead to severe infections such as sepsis that may be fatal. Peritonitis -- Inflammation of the peritoneal cavity containing all the internal organs -- can also occur, leading to life-threatening infections or abscess formation.
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