Appendicitis

What Is Appendicitis? What Causes Appendicitis?

Appendicitis is a condition in which the appendix becomes swollen, inflamed, filled with pus. The appendix is a small pouch shaped like a small finger. It is on the right side of the abdomen, connected to the colon.

Experts are not sure what the appendix is for. Charles Darwin theorized that even though the appendix has no use for modern humans, it might have been an organ our ancestors used to digest plants. Recent studies indicate that it may be a dedicated environment for friendly bacteria which facilitate digestion and fight infection.

Appendicitis generally strikes people aged between 10 and 30, but it can affect people of any age. Approximately 250,000 appendectomies are performed in the United States each year to treat apendicitis.

What causes appendicitis?

Experts believe there are two likely causes:

• Infection - a stomach infection may have found its way to the appendix. 
• Obstruction - a hard piece of stool may have got trapped in the appendix. The bacteria in the trapped stool may then have infected the appendix.

Scientists at the University of Calgary, Canada, found a link between high pollution levels and a higher incidence of appendicitis.

What are the symptoms of appendicitis?

Initially, some pain can be felt anywhere in the stomach area, but later, as it intensifies, its location becomes more defined in the lower right-hand side of the abdomen - an area known as McBurney point.

The following symptoms are common:

• Progressively worsening pain
• Coughing or sneezing is painful
• Nausea
• Vomiting
• Diarrhea
• Inability to pass gas (break wind, fart)
• Fever
• Constipation
• Loss of appetite

Anybody who experiences a progressively worsening pain in the abdomen should seek medical attention. Other conditions may have similar symptoms, such as urinary tract infection; even so, they all require urgent medical attention.

Diagnosing appendicitis

Diagnosing appendicitis can be challenging. Half of all patients who have appendicitis do not have typical symptoms - the pain may be located in different parts of the body. Other conditions may have very similar symptoms, such as gastroenteritis, urinary tract infection, ectopic pregnancy, Crohn's disease, or a kidney stone.
Not everybody has their appendix in exactly the same place - some are located behind the colon, behind the liver, or in the pelvis.

A GP (general practitioner, primary care physician) will examine the patient and ask some questions related to symptoms. He/she will apply pressure to the area to see if it worsens the pain.

If typical appendicitis signs and symptoms are detected, the GP will diagnose appendicitis. If they are not, further tests will be ordered:

• A blood test - to determine whether there is an infection.
• Urine test - this will identify a kidney or bladder infection. Researchers at the Proteomics Center at Children's Hospital Boston, USA, demonstrated that a protein detectable in urine might serve as a biomarker for appendicitis.
• An MRI, CT or ultrasound scan - to view a 3-D image of the appendix and see whether it is inflamed (swollen). Color Doppler ultrasound, not CT, should be the first imaging examination for adult patients with suspected acute appendicitis, say researchers at Rambam Health Care Campus in Haifa, Israel.

Sometimes a decision will be made to surgically remove the appendix because it is too risky to wait around for the tests to confirm the diagnosis.

Researchers at the University of California, Los Angeles, found that pregnant women suspected of having appendicitis are often misdiagnosed and undergo unnecessary appendectomies that can result in early delivery or loss of the fetus.

What is the treatment for appendicitis?

Doctors may decide to treat the patient with antibiotics. This is rare and the infection would need to be very mild. In most cases an appendectomy will be performed - the appendix will be surgically removed.

• Laparoscopy (keyhole surgery)
  
  Laparoscopic surgery is also known as minimally invasive surgery (MIS), bandaid surgery, or keyhole surgery. The surgeon inserts a very thin tube (laparoscope), which has a tiny video camera and its own lighting, into the abdomen through a cannula. A cannula is a hollow instrument.
  
  Thanks to the tiny video camera, the surgeon can view the insides of the abdomen with magnification on a monitor. Tiny instruments respond to the movements of the surgeon's hands and the appendix is removed through small abdominal incisions.
  
  Thanks to the precision of the operation, minimal loss of blood, and the need for very small incisions, the patient recovers much faster and with less scarring, compared to traditional open surgery. In most cases it is no longer necessary to open the patient up with a large incision.
  
  However, a report in the Journal of the American College of Surgeons suggests that a traditional, open appendectomy may be preferable to a less-invasive laparoscopic appendectomy for most patients with acute appendicitis, contrary to recent trends. Apparently, laparoscopic surgery increases costs and may raise the risk of complications in the majority of appendectomy patients.
• Sometimes traditional surgery is necessary
  
  If the appendix has ruptured and infection has spread, or if there is an abscess, a larger incision will be made so that the area inside the abdominal cavity can be cleaned.
  
  Traditional appendectomy is also used if the patient has tumors in the digestive system, if a woman is in her third trimester of pregnancy, or if the patient had many abdominals surgeries before.
  
  After the operation the patient will be given antibiotics intravenously.
• Delaying surgery
  
  If the patient has had symptoms for at least five days the doctor may recommend a course of antibiotics in order to shrink the appendix and clear up surrounding infection, and perform surgery later.
  
  If there is an abscess the doctor may decide to drain it first and operate at a later date.

What are the complications of appendicitis?

• Peritonitis
  
  If the appendix ruptures and releases the infection into the abdomen the patient may develop peritonitis. The peritoneum will become inflamed. The peritoneum is the membrane that lines the abdominal cavity and covers most of the abdominal organs. Peritonitis causes the bowels to shut down - bowel movements will stop and the bowel will become blocked. The patient will develop a fever and could go into shock. Peritonitis requires urgent treatment.
• Abscess
  
  If the infection seeps out of the appendix and mixes with intestinal contents, it may form an abscess. If the abscess is not treated it can cause peritonitis. Sometimes abscesses are treated with antibiotics. Often they are surgically drained with the aid of a tube which is placed into the abdomen.

Prevention

Countries with lower incidences of appendicitis also tend to have more fiber in their people's diets, compared to other countries. It would therefore be logical to assume that a high fiber diet may help reduce your chances of developing appendicitis. One theory is that with a high fiber diet the resulting softer stools are less likely to get trapped in the appendix.

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