Appendicitis

Appendicitis is an inflammation of the appendix. It causes severe pain in the abdomen and can be treated surgically. An appendectomy is an operation to remove the appendix.

The appendix is a small tube, shaped rather like a finger. The average appendix is approximately 4 inches long and about 0.31 inches in diameter. It is closed at one end, and at the other is attached to the cecum, a pouch shaped part of the colon of the large intestine. This section of the large intestine is near to the place where it is joined to the small intestine. Food travels from the stomach, through the small intestine and into the large intestine, passing the appendix on its way.

Type of Organ

The appendix itself is usually considered to be a vestigial organ, that is one that no longer has any function. Some research points to possible secondary functions for the appendix, but it is not an essential organ, and it is possible for a human to live a perfectly healthy life without an appendix. One secondary function that has been suggested for the appendix is that it could provide an environment in which useful bacteria can grow, and perhaps one in which they can survive when illness, specifically diarrhea, flushes bacteria out of the digestive system. Another suggestion is that the appendix could play a role in the immune system, since it usually contains many lymphoid cells, which are involved in the fight against infections.

Appendicitis is a common condition that affects one in every fifteen Americans. It usually presents in patients between the ages of 10 and 30, and is very rare in children under 2 years of age.

Medical Emergency

Appendicitis is a medical emergency that requires immediate attention. If left untreated it can be fatal, since the inflammation can increase until the appendix bursts, releasing the contents of the intestine and infectious material into the abdomen. The resulting infection, known as peritonitis, requires strong antibiotic treatment in order to save the patient. If left untreated, the patient can go into shock and die.

Appendicitis? Get Remedies Fast!

Abscesses, which are pockets filled with pus, can sometimes form on the outside of an infected appendix. These must be treated before the appendix can be removed. If the abscess tears, the pus will leak into the abdomen, where it could spread the infection.

In some cases, the infected appendix can be sealed off from the abdomen by scar tissue produced by this type of abscess on the outside of the appendix. This can prevent peritonitis, since it becomes impossible for infectious material to be leaked from the appendix. It is not possible to recognize an abscessed appendix before conducting surgery, however, therefore all cases of appendicitis must be treated as emergencies with the potential to develop into peritonitis.

Symptoms

The first symptom of appendicitis is a dull pain that occurs near the upper abdomen or navel. It then moves down towards the lower right of the abdomen, becoming a sharp pain over a period of several hours. The pain generally increases over approximately 12 to 18 hours, becoming very severe. The patient will often be unable to find a comfortable position or to sit still, due to the pain. In some cases, the pain may occur in a different part of the abdomen than would usually be expected, particularly when the patient is a child or a woman who is pregnant.

Other common symptoms are:

• Nausea or vomiting, soon after the abdominal pain begins
• Loss of appetite
• Swelling of the abdomen
• A fever (99 to 102 degrees Fahrenheit)
• An inability to pass gas

Some patients may also experience other symptoms. In approximately half of the people who have appendicitis, there will also be a sharp or dull pain elsewhere in the abdomen, the back or the rectum, cramps, diarrhea with gas, constipation, pain when urinating, or vomiting before the abdominal pain begins.

Anyone who is experiencing the symptoms of appendicitis should seek medical attention as quickly as possible. Many people begin by making an appointment with their family doctor, since their symptoms have not yet become severe. If the doctor suspects appendicitis, they will then be referred on to a surgeon. If the pain has become severe, then the patient is likely to seek help at the emergency room instead, and be transferred to surgery from there.

Diagnosis

If a patient arrives at the hospital or a family doctor’s offices with abdominal pain that may be appendicitis, the doctor will want to know how long the pain has been there, how severe it is, where exactly in the abdomen it is, and whether there has been any change in the pain since it first began. They will also ask whether there have been any other symptoms.

A doctor will perform a number of diagnostic tests when a patient presents with some or all of the symptoms of appendicitis. A number of other conditions can cause similar symptoms, therefore it can be difficult to correctly make the diagnosis, and the patient may not be able to recognize the condition for themselves.

The doctor will physically examine the abdomen to check for any inflammation. They will probably press down upon the abdomen and ask the patient whether there is any change in the pain. In cases of appendicitis, the pain increases when the pressure is released. This happens because the peritoneum is inflamed. The doctor will also check for any rigidity in the abdomen, and whether the patient’s muscles are reacting to the pressure by becoming tense. This is known as guarding, and is common during appendicitis.

They will usually also perform a rectal exam and conduct tests on the blood and urine to check whether the body is fighting off an infection and to rule out the possibility that the patient is actually suffering from a urinary tract infection. A high count for white blood cells in the blood test implies that the patient has some sort of infection. Urine tests can identify urinary tract infections, and if there is are red blood cells in the urine when it is examined under a microscope, it suggests that the pain is being caused by kidney stones rather than appendicitis.

A CT scan or an ultrasound may also be used to investigate the abdomen. This can confirm the diagnosis of appendicitis, or find any other reasons why the person could be suffering from abdominal pain.

It is usual for the doctor to recommend surgery whenever appendicitis is suspected, even if they are not entirely certain that the patient is suffering from this condition, since it is vital to operate as quickly as possible if the condition is present.

Causes

Appendicitis occurs when the appendix is blocked. This blockage can be caused by stool, a foreign body, cancer, or swelling of the appendix due to an infection.

Risk Factors

Anything that increases the chances of a blockage that could affect the appendix can increase the risks of developing appendicitis.

There is no way to prevent appendicitis, but when the symptoms do occur, it may be possible to reduce the chances of the appendix rupturing. The best way of preventing this is to get medical attention before the appendix can burst, but there are certain things that anyone with suspected appendicitis should avoid, since they can cause an inflamed appendix to rupture. They should not eat or drink anything, take any pain medication, laxatives or antacids, or use a heating pad.

People who eat plenty of fiber are less likely to suffer from appendicitis, so a diet rich in fruits and vegetables may reduce the chances of developing this condition.

Treatments

Appendicitis is treated by surgical removal of the appendix. A dose of antibiotics is usually given before the operation in order to protect the patient from the possibility of peritonitis developing.

If the appendix has abscessed, then the patient may need to have an operation to drain the pus before the appendectomy is performed. The pus is drained through a tube that is inserted into the abscess. The patient will usually need a few weeks to recover from this procedure before the appendix can be removed. Patients who have an abscessed appendix will therefore require two separate operations.

If the appendix has burst, then treatment with antibiotics will also be necessary in order to cure the resulting infection, which is known as peritonitis, since the lining of the abdominal cavity is called the peritoneum.

There are two ways in which an appendectomy can be performed. Both require a general anesthetic, which will put the patient to sleep while the surgery is performed.

An open appendectomy requires an incision of about four inches in length to be made in the abdomen, through which the appendix is removed. If the appendix has ruptured, or if there is an abscess on the appendix, then an open operation will probably be necessary, since it provides the surgeon with the opportunity to clean out the abdominal cavity.

A laparoscopic appendectomy is conducted through a number of much smaller incisions in the appendix. This technique uses a laparoscope, which is a thin instrument with a camera on the end of it that can be inserted into the abdomen and used to find the appendix and provide a view inside while performing the procedure. Since the incision is smaller, patients whose appendectomy was laparoscopic will usually recover from the operation faster from those whose operation was open.

After the surgery, the patient will usually need to take pain medication while the incision is healing. There are no alternative therapies that can help to treat appendicitis, but there may be strategies that can help the patient to cope with the pain they experience while recovering. Some patients benefit from techniques such as guided imagery while dealing with postoperative pain. This involves imagining a favorite place in order to create a distraction from the pain. Other activities such as listening to music, watching TV, reading or talking with a friend, can also help patients to forget about the pain.

There is some recent evidence that antibiotics alone may be an effective treatment in some cases of appendicitis, without the patient having to undergo surgery. This treatment is currently being tested in clinical trials. It depends upon recognizing which patients are at low risk of the appendix rupturing, which there is not currently a reliable means of doing.

Traditional Remedies

There are no traditional cures that can treat appendicitis, but there are some remedies that have been used in the past to cope with this condition. None has been scientifically proven to be effective, and it is essential that anyone who suspects they have appendicitis visits their doctor and receives proper treatment.

In Traditional Chinese Medicine, certain herbs are believed to be able to treat appendicitis. A scientific study was conducted on 425 patients with appendicitis. They were given herbal preparations from Chinese medicine. Some patients also received antibiotics. Most of the patients who were included in the study experienced an improvement in their condition, without having an appendectomy, but 30 of the patients relapsed with appendicitis soon afterwards. Although these results are interesting, and may suggest possible research topics for the future, surgery is still the only option for curing appendicitis.

In addition to herbal remedies, acupuncture and electro acupuncture have been used in Chinese medicine in order to treat appendicitis. No clinical trials have been conducted to test the efficacy of these treatments.

Outside of the Chinese tradition, other cultures have attempted to treat appendicitis with herbal remedies. Homeopathic remedies for the condition include Bryonia and Belladonna. Indian ayurvedic medicine suggests a number of remedies for mild cases of appendicitis, including drinking buttermilk, carrot or beetroot juice, or water in which fenugreek seeds have been boiled. There is no scientific evidence that any of these herbal remedies work for appendicitis.

Traditional remedies are unlikely to help in cases of appendicitis, although some may help to improve the digestion or to alleviate some of the symptoms. In ayurveda, for example, ginger is suggested as a remedy for nausea and vomiting.

Alternative therapies for appendicitis probably only exist because of the difficulty in diagnosing the condition, which may have led to supposed cures when the patient did not in fact have appendicitis. Practitioners may also have believed that they cured appendicitis when the condition was very mild and resolved itself, with no help from their remedies. This could have led to the treatment being passed down over the generations as a remedy that was believed to help people with appendicitis.

Prognosis

If the condition is treated quickly, with an appendectomy and antibiotic treatment if the appendix has burst, then the prognosis is good. The patient should expect to spend a day, or possible two days, in the hospital after receiving the surgery. It will take up to three weeks for the patient to recover from the operation, but there should be no further problems and they will be able to lead a completely normal life, without their appendix. Open surgery requires a longer healing period than laparoscopic surgery. The patient will also take longer to recover from their appendicitis if the appendix burst before it could be removed.

Patients who have had an appendectomy should contact their doctor if they experience any dizziness or faintness, uncontrolled vomiting, blood in their urine or vomit, increased pain in the abdomen or the incision, redness or pus in the incision.

During the recovery period, the patient can take a number of measures to help themselves to heal and to avoid complications resulting from the surgery. They should avoid any strenuous physical activity. If the procedure was performed laparoscopically, they will need to limit their activity for between three and five days after the surgery. If their operation was open, then they should avoid any physical strain for ten to fourteen days afterwards. The recovery time will vary between patients, but the doctor will be able to advise on when each patient can return to their normal activities.

While the patient is recovering, they should be careful when they are coughing, laughing or otherwise placing a strain on their abdomen. They may feel some pain when doing any of these things. The abdomen can be protected during these actions by placing a pillow across the abdomen and placing pressure upon it in order to brace the stomach.

Once the patient is ready to begin moving around again, they should begin gradually and start with short, sedate walks. It is important that the patient does not try to push themselves too hard before they are ready to return to their normal lifestyle. The doctor will be able to advise the patient on when they should expect to go back to work or take up other activities again. Children who have undergone an appendectomy are usually able to return to school after about a week, as long as they avoid any particularly strenuous activities such as sports and gym classes, which they should usually avoid for between two and four weeks after surgery.

While they are recovering, the patient should ensure that they get plenty of rest and sleep. The healing process can use up a lot of energy, and they may require more sleep than they normally get, and could feel sleepier than usual.

The patient will probably be taking some pain medication during the recovery period. If this is not effective, then they should contact their doctor in order to discuss the problem. They may need to take a different type or dosage of medication, or there may be a complication with the healing incision.

Complications

Any surgery that requires a general anesthetic presents some risk to the patient. There is also a chance of a postoperative infection. If the appendix ruptured prior to removal, then complications are more likely to develop due to the spread of infectious material through the abdomen. There is a 59 percent chance of a complication occurring after a burst appendix, compared to a chance of 3 percent when the appendix was removed before it could burst.

There are an estimated two cases per million in which appendicitis leads to death in the US, due to the high levels of health care that are available. Death is usually caused by peritonitis after an untreated appendix has ruptured.

Cost

An appendectomy can be expensive since it is a surgical procedure and because it usually requires a stay of at least a day in hospital. Some patients may need to stay for several days. A number of tests are also required before the diagnosis of appendicitis is made.

There are stories of people in the US paying up to $30,000 for appendicitis treatments, but the cost is usually lower than this. It is not unusual for the patient to pay between $10,000 and $20,000. The Healthcare Blue Book, a guide to medical costs, lists the price of an appendectomy carried out in the US in 2010 as $10,856. This price is based on the average fees charged to patients, but some people will be asked to pay more than this.