Appendicitis

• Symptoms: Sudden onset of pain in the abdomen, shifting pain in the navel to the right side of the abdomen, Extreme pain during coughing and movements, intense pain disrupting sleep, nausea and vomiting, fever, constipation, loss of appetite, bloating in the abdomen 
• Causes: Blocked appendix, buildup of toughened stool, inflammation of lymphoid follicles, worms in the intestines, trauma or injury, tumors
• Risk Factors: Family history, age, patients with cystic fibrosis
• Severity: Mild to severe
• Which doctor to consult: General Surgeon

Overview

An appendix is a small tube-shaped pocket at the end of the large intestine. Appendicitis occurs when the appendix is obstructed and inflamed. The condition may also result from bacterial, viral or parasitic infection in the digestive tract. It can occur in the form of chronic or acute type.

In appendicitis, the blood supply to the appendix is restricted due to the swelling in the area. In the absence of enough blood flow, the cells in the appendix begin dying. Additionally, the blockage provides ample space for the microorganisms like bacteria to fester and cause infections.

In the prolonged presence of appendicitis, the walls of the appendix may rupture, causing the leaking of stool outside the organ in the gastrointestinal system. This can cause a life-threatening disease called peritonitis.

After the onset, the condition causes symptoms like abdominal pain, low-grade fever, travelling pain from the navel to the lower abdomen, constipation, diarrhoea, vomiting, difficulty releasing gas and more. The symptoms vary from one person to another. In pregnant women, the symptoms may appear similar to the regular discomforts faced during pregnancy, like bloating. Additionally, in these patients, the pain doesn't occur in the lower abdomen.Instead, it appears on the upper side of the organ.

Within 24 hours of the symptoms' appearance, the chances of facing a rupture increase. That's the reason it's imperative to take medical help as soon as the signs start occurring.

Generally, the doctor recommends a series of tests to understand the severity of the appendicitis. The prescribed tests include blood tests, urine assessments, abdominal ultrasound or CT scans.

After a positive diagnosis, experts suggest surgery which can be of two types, i.e., open and laparoscopic. In appendix surgery or appendectomy, the general surgeon removes the appendix.

When to Consult a Doctor?

• On Symptoms

Patients must seek medical attention as soon as they witness symptoms. The symptoms can range from shooting pain in the lower right side of the abdomen to discomfort in the area. The typical signs of appendicitis are fever, difficulty passing gas and stool, bloating, pain interrupting sleep and more.

Since the disease can progress into a life-threatening form called Peritonitis due to the rupture of the appendix, urgent medical attention is of extreme importance. In the event of a rupture, the collected excreta or pus may spread to the other parts of the gastrointestinal system leading to infection.

• Routine Checkup

Regular checkup, incase of mild symptoms, is more important if a woman is pregnant. During pregnancy, the signs of appendicitis resemble the usual inconvenience caused by the bulging abdomen, like flatulence and cramps. This similarity makes it difficult to differentiate between the symptoms of other diseases. Delayed treatment of appendicitis during pregnancy can result in fetal and maternal complications.

• After Medications

Generally, doctors recommend various medications, including antibiotics, to treat appendicitis caused due to infection. If, even after the completion of medication consumption, the symptoms of appendicitis don't subside, an individual must seek urgent medical attention. Usually, the treatment of appendicitis with medications is successful in the early stage and in uncomplicated form of appendicitis with lower perforation of the abdomen.

Diagnosis

• Preliminary Analysis

At first, the medical practitioners assess the severity and root cause of appendicitis through examination of the patient’s medical records. It involves asking for medical history involving any previous condition associated with the occurrence of symptoms.

It can also include digital rectal evaluation to check for tumours. Additionally, for female patients, the doctors conduct another assessment of the vagina, cervix and vulva to rule out pelvic inflammatory conditions.

• Blood Tests

Appendicitis is usually accompanied by a variety of infections. In fact, an abdominal infection or UTI can cause similar symptoms as appendicitis. To confirm the condition, doctors prescribe a complete blood count (CBC) test which analyses the signs of infection through the change in blood structure.

An increase in the white blood cell count directly indicates possible infection in the body. Moreover, the doctor can also recommend a C-reactive protein test to examine the presence of any autoimmune disorder.

• Urine Tests

Kidney stones can also have similar symptoms. On top of this, a urinary tract infection also causes similar signs. To ensure the presence of appendicitis, doctors recommend different tests involving urine examination to eliminate other diseases.

• Imaging Tests

After eliminating other possibilities, experts suggest scanning the abdomen to locate the affected area and the condition’s intensity. These tests include abdominal ultrasound, X-rays, MRI, and CT scan.

Through these methods, doctors identify potential reasons behind the symptoms, including faecal impaction, abscess, and inflammatory bowel disease other than appendicitis.

These examinations help in getting a detailed picture of the internal damage caused by appendicitis. Additionally, these also help in gaining a thorough chest analysis to rule out pneumonia.

MRI tests are generally recommended if a patient is pregnant. Undergoing these examinations might involve fasting for hours depending upon the procedure and expert recommendation.

Treatment

• Antibiotics

If detected with mild forms of appendicitis, doctors can recommend  antibiotics. The suggested medications may help in relieving the infection symptoms. During the duration of medication, doctors keep a close watch on the patient’s condition to analyse if surgery is required. Generally, antibiotic treatment is a preliminary step taken to prepare the patient's body for surgery of the appendix or appendectomy.

• Needle Drainage

In the case of the detection of pus-filled sacs in the abdomen, the needle drainage method is utilised. Doctors use scanned images throughout the procedure to insert the needle in the abscess. Using the plunger pus is extracted from the sacs. The fluid is later assessed to understand the antibiotics required post-surgery. Additionally, the patient is also prescribed intravenous antibiotics to treat the condition.

• Surgery

If there's a high likelihood of organ rupture and antibiotics fail to yield any results, doctors resort to appendectomy surgery. This procedure involves removing the appendix, a vestigial organ in the body. Generally, the surgeries are of two kinds: open and laparoscopic.

In the open appendectomy, incisions of 2-4 inches are made on the abdomen to remove the appendix. In contrast, laparoscopic appendectomy is a minimally invasive procedure where a digital device is inserted after a small incision to remove appendix.

That being said, laparoscopic surgery is performed only on patients whose appendix hasn't ruptured. After the appendix burst, the infection spreads to other parts, which requires open surgery to clean the abdominal cavity.

Risk and Complications if Left Untreated

• Peritonitis

The prolonged presence of appendicitis can lead to rupturing of the organ. Due to the burst, the infection of the appendix spreads to the gastrointestinal system. As this condition causes an inflammation of the inner abdominal lining, it leads to fluid accumulation inside the belly, causing severe dehydration. If left untreated, it can lead to life-threatening complications by spreading to the entire body.

• Sepsis

Undiagnosed appendicitis results in the infection of the bloodstream. Due to the rupturing, bacteria can travel inside the blood and cause widespread inflammation in multiple organs simultaneously, giving rise to sepsis. This complication can result in organ failure as well.

• Abscesses

Delayed appendicitis treatment can also cause an appendicular abscess. It is a condition which leads to the creation of painful pockets of pus inside the abdomen. It is usually formed around the ruptured appendix.

Additional Information

• Symptoms of Peritonitis

Peritonitis is a condition which involves swelling and redness of the inner lining of the belly called the peritoneum.

It can occur due to a hole in the belly lining or from an appendix rupture. Some other reasons which can cause peritonitis include a hole in the intestine, fluid infection due to end-stage renal diseases, liver cirrhosis, pelvic inflammatory disease and bacterial entry during surgery.

The signs of peritonitis vary from one individual to another. The general symptoms of the condition include:

• Severe belly ache worsening with motion 
• Fever
• Swollen belly
• Fluid in the stomach 
• Less urine than usual
• Extreme thirst 
• Nausea
• Vomiting and fever
• Low blood pressure 
• Difficulty breathing 
• Causes of Appendicitis

There is no precise cause of appendicitis. It gets triggered by inflammation owing to infection in the appendix leading to irritation and swelling in the region. The most commonly found causes leading to appendicitis comprise:

• Injury or trauma in the abdomen 
• Blockage at the meeting point of the appendix and intestines 
• Infection of the digestive tract 
• Inflammatory bowel diseases 
• Tumourous growth inside the appendix