Appendicitis

Appendicitis: Overview

Appendicitis is an inflammation of the appendix, a small worm-like pouch attached to the large bowel.

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Incidence; Causes and Development

The appendix is a little dead-ended tube attached to our intestines, considered by many to be 'useless'.  In fact, most people don't spend much time thinking about it... until it becomes infected.  At that point the extreme pain and life-threatening nature of the infection is the only thing on their mind.

Appendicitis can happen at any age but most cases occur between 8 and 25 years of age; it is rarely seen in children aged under two years.  Among young people, appendicitis is probably the most common cause of stomach pain requiring emergency surgery.

In most cases, the specific reason for the inflammation is not known but it is sometimes caused by small pieces of hardened stool that get stuck in the appendix.

Signs and Symptoms

The symptoms can be extremely variable but often follow a classic pattern.  The first sign is usually a pain or discomfort in the center of the abdomen, which comes and goes in waves and is often thought at first to be a simple stomach upset.  After a few hours, the pain becomes more noticeable and constant in the lower right part of the stomach, increased by movement or coughing.  The patient often loses their appetite, feels sick, and vomits.  The temperature is raised and the complexion becomes flushed.  The breath may smell offensive.

In many such instances a careful clinical examination is as good as or better than expensive high-tech tests.  Six aspects of the history exam and the presence of at least four of seven physical symptoms provide the best method for diagnosing appendicitis without the aid of surgical methods.  Observation of right lower-quadrant pain, rigidity of the lower abdominal muscle wall and migration of pain from the left side to the right side of the abdomen are the three most prominent clinical findings that indicate a high probability of appendicitis.

Other clinical signs and symptoms that are found to be useful in accurately diagnosing appendicitis include pain before vomiting, irritation of the psoas muscle (found in the lower abdomen), fever, rebound tenderness, guarding (voluntary contraction of the abdominal muscle), no history of similar pain, rectal tenderness, anorexia, nausea and vomiting.

Diagnosis and Tests

There is no one test that will diagnose appendicitis with certainty.

Acute Appendicitis – Laboratory findings:

  • Early increase in WBC (to 12,000/ul – 14,000/ul; later up to 20,000/ul); more than 75% neutrophils with a "shift to the left"
  • Normal sedimentation rate

Laboratory findings of complications include dehydration – decreased urine volume; increased blood urea nitrogen (BUN), hematocrit, and urine specific gravity; abscess formation; increased sedimentation rate; peritonitis.

Complications

Some 20% of patients who undergo surgery turn out to have a ruptured appendix.  This increases the risk of peritonitis, a more widespread and serious abdominal inflammation.  Adhesions from postoperative scar tissue may develop and block or obstruct the bowel.  Fortunately, this only happens in a small number of all patients.  The condition usually occurs within three months of the operation.

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Risk factors for Appendicitis:

Medical Procedures

Counter-indicators

Recommendations for Appendicitis:

Surgery/Invasive

Surgery

Surgery is performed on the basis of a doctor's examination and the results of tests.  Many diseases can cause the same symptoms as appendicitis which is why surgeons find a normal appendix in some 3 out of 10 operations.  Surgical removal of the appendix (appendectomy) is the recommended treatment and is usually performed under general anesthesia.  In uncomplicated cases, a 2-3 day hospital stay is typical.

A 2002 study published in the journal Radiology found that among women who had a CT scan or ultrasound prior to having an appendectomy, a healthy appendix was removed just 7% of the time, compared with 28% of the time when no scan was done.

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