APPENDICITIS: CAUSES, LOCATION OF THE APPENDIX, SIGNS AND SYMPTOMS, SURGICAL TREATMENT AND COMPLICATIONS

OVERVIEW

 Appendicitis is a condition in which the appendix becomes swollen, inflammed and filled with pus. It is also known as Epityphlitis and mostly affects people between the ages of 10 and 30, although it can affect anyone. The two major causes include obstruction of the appendix by foreign bodies or a hard piece of faeces and viral or bacterial infection of the appendix. Signs and symptoms of appendicitis include aching pain that later intensifies in the lower right side of the abdomen, pain that increases during coughing, sneezing, walking or other jarring actions, vomiting, nausea, loss of appetite, etc. Acute appendicitis is best treated with Appendectomy (surgery to remove the inflammed appendix). If an inflammed appendix ruptures or its contents seeps out into the abdomen, complications such as Peritonitis or Appendiceal abscess result

An inflammed appendix - Apendicitis

Appendicitis,also known as Epityphlitis, was first described by Reginald Fitz in 1886 and is currently one of the most common and significant causes of severe and acute abdominal pain worldwide.

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LOCATION OF THE APPENDIX

The appendix is a small, finger-shaped pouch that projects out of the colon (large intestine) on the lower right side of the abdomen. The human appendix is thought to be a vestigial structure, a structure that has lost most or all of its original function through the process of evolution. Charles Darwin (an English naturalist and geologist, best known for his contributions to evolutionary theory) suggested that the appendix was used by our primitive ancestors for digesting leaves. However, one thing we do know is that we can live without it, without any problems.

The appendix is a small, finger-shaped pouch that projects out of the colon (large intestine) on the lower right side of the abdomen.

Appendix can affect anyone, but it most often occurs in people between the ages of 10 and 30

CAUSES

The causes of Appendicitis is not very precise. However, it is most likely caused by 2 factors.

1. Obstruction: Food waste, foreign bodies, or a hard piece of faeces (known as appendicoliths or faecaliths) can block the appendix lumen (the inside space of a tubular structure). Once this obstruction occurs, the appendix subsequently becomes filled with mucus and swells, increasing the pressure within the lumen and the walls of the appendix

A hard piece of faeces (Faecalith) blocks the lumen of the appendix. This subsequently causes the outer part to become infalmmed

2. Infection: Appendicitis may also be caused by a stomach infection, such as a gastrointestinal viral infection, or it may result from other types of inflammation.

In both cases above, bacteria inside the appendix multiply rapidly, causing the appendix to become inflammed, swollen and filled with pus. If not treated promptly, the appendix can rupture

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SIGNS AND SYMPTOMS

These include:

• Aching pain that begins anywhere in the stomach area (or sometimes around the navel) but later, as it intensifies, its location becomes more defined in the lower right side of the abdomen (an area known as the McBarney's point) - this is usually the first sign

• Progressive worsening of the pain

• Tenderness is felt when pressure is applied to the lower right abdomen.

• Sharp pain that is felt in the lower right abdomen when the area is pressed on and the pressure is quickly released. This is known as rebound tenderness

• Pain that increases during coughing, sneezing, walking or other sudden movements

• Vomiting

• Nausea

• Loss of appetite

• Diarrhea

• Low grade fever

• Inability to pass gas

• Constipation

The location of the pain may vary depending on age and location of the appendix.

TREATMENT

Acute appendicitis is a medical emergency that requires immediate surgery to remove the appendix. While antibiotics are effective for treating uncomplicated appendicitis, 20% of people had a recurrence within a year and eventually required surgery.

Surgery: The surgical procedure for the removal of the appendix is called an Appendectomy or Appendicectomy and it can be done in 2 ways

1. Laparotomy: This is the traditional and most common type. It involves placing the patient under general anesthesia to keep the mucsles completely relaxed and the patient unconscious. A 5 - 10cm long incision is then made in the lower right abdomen, several inches above the hip bone, opening up the abdominal cavity. The surgeon then cuts the appendix from the surrounding tissue. After close inspection of the tissues, the surgeon stitches up the skin and covers it with a sterile bandage to prevent infections

2. Laparoscopic surgery: This is also known as Keyhole surgery. This surgical procedure involves making 3 to 4 tiny incisions in the abdomen. The surgeon then inserts a very thin tube (called a Laparoscope) into the abdomen through one of the incisions. This tube has a tiny video camera and its own lighting system. Using a monitor to which the laparoscope is connected, the surgeon will be able to clearly see the interior of the abdomen. From the other incisions, using small surgical instruments, the surgeon can then precisely cut off the appendix.
The advantages of this method are: It allows for a high level of precision. There is minimal loss of blood. The incisions are very small. The patient recovers much faster with less scarring compared to Laparotomy. However, it can not be used if the appendix has already ruptured or if an abscess is present

*Incision is cut into a body tissue or organ, especially one made during surgery*

A scar left by an appendectomy surgery

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COMPLICATIONS

Complications associated with appendicitis include:

Peritonitis: If the appendix ruptures or bursts, it spills infectious materials into the abdomen and the person may develop Peritonitis (Inflammation of the Peritoneum). The Peritoneum is the membrane that lines the abdominal cavity and covers most of the abdominal organs. Peritonitis can be fatal and requires urgent treatment

Appendiceal Abscess: If the infection seeps out of the appendix and mixes up with the intestinal contents, it may form an abscess - a pocket of infection around the appendix. Appendiceal abcess requires requires treatment before the abscess tears, causing a more widespread infection of the abdominal cavity.

Appendicitis is best prevented by eating foods with a fibre content. One theory behind this preventive measure is that, since a fibre diet results in softer faeces, these faeces are less likely to get trapped in the appendix


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