HEALTH TALK: Appendicitis

Appendicitis means your appendix has become inflamed and filled with pus. Your appendix is a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. It has no known essential purpose, but that doesn’t mean it can’t cause problems.

The main symptom of appendicitis is pain that often starts around your navel and then shifts to your lower right abdomen, where your appendix is. The pain usually increases over a six to 12 hour period, and may eventually become very severe. Anyone can get appendicitis, but it mostly strikes people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix (appendectomy).

SIGNS AND SYMPTOMS

Appendicitis can cause a variety of symptoms that may change over time:

•    Early on, the most common symptom is an aching pain around your navel that often shifts later to your appendix area.

•    As the inflammation spreads to nearby tissues, the pain may become sharper and more severe.

•    Eventually, the pain tends to settle in your lower right abdomen near your appendix at what’s known as Mc Burney’s point, about halfway between your navel and the top of your right pelvic bone.

The location of the pain may vary, however, depending on your age and the position of your appendix. Young children or pregnant women, especially, may have appendicitis pain in different places.

What worsens pain is if you apply gentle pressure to the painful area; if you do it and release suddenly, the pain worsens (rebound tenderness). If you cough, walk or make other jarring movements, pain increases, especially if the inflamed appendix is touching the peritoneum, the membrane that lines the inner abdominal wall and enfolds the intestine. Pain may lessen if you lie on your side and pull your knees up toward your chest.

Other non-pain symptoms may include, in addition to the pain:

•    Nausea and sometimes vomiting.
•    Loss of appetite.
•    Constipation.
•    A low-grade fever that starts after other symptoms appear.
•    An inability to pass gas.
•    Abdominal swelling.
•    Diarrhea.

CAUSES

This is not always clear. Sometimes it’s the result of:

•    An obstruction. Food waste or fecal stone (hard piece of stool) can become trapped in an opening of the cavity that runs the length of your appendix.

•    An infection. Appendicitis may follow an infection, such as a gastro-intestinal viral infection, or it may result from other types of inflammation.

In both cases, bacteria may subsequently invade pretty fast, causing an inflamed appendix filled with pus. If not treated promptly, your appendix may rupture.

WHEN TO SEEK MEDICAL ADVICE

Children are more likely to have a ruptured appendix than adults. Children don’t always have the typical symptoms of appendicitis, and parents may delay getting treatment. So it’s best not to take abdominal pain lightly. Even if you suspect a “stomachache” isn’t serious, call doctor to make sure.

Older persons also have a higher incidence of ruptured appendix, possibly because of delay in seeing doctor for abdominal pain.

SCREENING AND DIAGNOSIS

Other conditions may cause abdominal pain that resemble that of appendicitis, so it’s always important to keep other things in mind-the doctor, that is. They include:

•    Ectopic pregnancy. A pregnancy in a place other than the womb is ectopic, and can cause similar pain.

•    Certain ovarian cysts. A right-sided ovarian cyst may cause pain in the same general area as appendicitis.

•    Kidney stone. Occasionally, a right kidney stone will pass into the ureter, the tube form the kidney to the bladder, and get stuck there. This causes a serious pain, and may seem like appendicitis, especially in adults.

•    Chron’s disease. This causes inflammation of the digestive tract; may mimic appendicitis.

To Make a Diagnosis

To help diagnose appendicitis, doctor will ask you a bunch of questions and do the usual examination, including eliciting rebound tenderness. Doctor may watch for rigidity of the abdomen and guarding (a tendency to stiffen you abdominal muscles in response to pressure over the inflamed appendix).

Doctor may also order:

•    Blood test, to look for a high white blood cell count, which may indicate an infection. This is not always found, though.

•    Urine test. This will help to rule out a urinary tract infection (UTI) or a kidney stone. The latter may cause red blood cells to be seen or microscopic examination of the urine.

•    Imaging tests. X-Rays and ultra sound scans can be helpful in making a diagnosis. CT scans are also useful, but women of child bearing age must be sure they’re not pregnant first, because CT scans will deliver some radiation.

COMPLICATIONS

Rupture of the appendix is the most serious complication. Intestinal contents and infectious organisms invade the abdominal cavity. This can cause peritonitis, infection of the lining of the abdominal cavity.

You may suddenly feel better when this happens, but soon your abdomen becomes distended with gas and fluid, feeling tight, hard and tender to the touch throughout.

Peritonitis is a medical emergency. Go to the emergency room if you have signs.

Sometimes, infection and seepage of intestinal contents may form an abscess, a walled- off area of infection (appendiceal abscess). It may be wall-nut sized or grapefruit-sized; regardless, it needs to be treated before it perforates, causing peritonitis.

TREATMENT

Surgical removal of the appendix is necessary, be it by conventional or laparoscopic surgery.

If you’ve had symptoms for five or more days, immediate surgery may cause complications. In this case, antibiotics may first be tried to shrink the inflammation and infection that may surround structures near the appendix. If an abscess is present, it may be drained through the skin. If this is successful, your appendix is removed a couple of months later.

See you next week.

Dr. Victor Emanuel has been an educator of medical professionals in training, and the public, for over 20 years in Dominica. The contents of his articles are based on facts and research conducted, and not of his opinion.