Appendicitis: Symptoms, Complication, Diagnosis & Treatment

 

When your appendix becomes clogged, infected, and inflamed, you develop appendicitis.  The appendix is a little organ that resembles a tube and is attached to the large intestine.  Although its exact function is unknown, we do know that appendicitis is a serious condition.  Surgery to remove your appendix is the usual course of treatment.

Appendicitis is inflammation of the appendix.The appendix is a finger-shaped pouch that protrudes from the colon on the lower right side of the abdomen, commonly referred to as the stomach.

Appendicitis produces pain in the lower right side of the abdomen. However, in most people, pain starts at the belly button and subsequently spreads. Appendicitis discomfort usually increases with inflammation and finally becomes serious.

Although anyone can get appendicitis, it most commonly affects adults between the ages of 10 and 30. Antibiotics are typically used to treat appendicitis, followed by surgery to remove the appendix in most cases.

Also Read: Gastritis: Symptoms, Causes, Risk factors, Treatment & Prevention

What is appendicitis?

 An inflamed appendix is known as appendicitis.  It may result in lower abdominal pain that is acute—that is, abrupt and severe.  About the size of a finger, your appendix is a tiny, tubular pouch that emerges from the lower right end of your big intestine.  Inflammation can result from poop (feces) blocking or infecting your appendix as it passes through your large intestine.  When your appendix swells due to inflammation, it may burst.

An appendix burst is a serious medical emergency. It spreads bacteria throughout your abdominal cavity from inside your intestines. Sepsis, a potentially fatal consequence, may result from this infection (peritonitis) spreading to your bloodstream. Due to this risk, appendectomy—the removal of the appendix—is the usual therapy for appendicitis. You won't miss it, as your appendix isn't a necessary organ.

What distinguishes acute from chronic appendicitis?

Nearly all cases of appendicitis are acute, meaning they start abruptly and get worse quickly. The majority of our knowledge regarding appendicitis pertains to acute appendicitis, which is extremely prevalent. We don't know much about chronic appendicitis, a rare condition. It seems to happen when anything irritates your appendix intermittently over an extended period of time, yet it never gets worse.

Because the symptoms of chronic appendicitis may not worsen as they do in acute appendicitis, it may go undiagnose. However, appendicitis of any type is serious. It's crucial to consult a healthcare professional if you have persistent stomach pain and are unsure of its source. Acute or worsening chronic appendicitis can occur at any time. Healthcare providers handle it similarly due to this risk.

What is the commonality of appendicitis?

Acute appendicitis is common, particularly in people aged 10 to 30. Although younger children can also acquire appendicitis, it is most frequent among teenagers. Approximately 5% of Americans will experience acute appendicitis at some point in their lives. It is the primary cause of stomach pain that necessitates urgent abdominal surgery. Roughly one percent of people get chronic appendicitis.

What symptoms of appendicitis are present?

Loss of appetite, nausea, and stomach discomfort are the most typical signs of appendicitis. Appendicitis can be identified more easily because of the typical way these symptoms manifest. Unfortunately, only roughly 50% of appendicitis patients exhibit the typical clinical presentation. People who are pregnant, old, or children may not exhibit the usual symptoms.

What are appendicitis's early warning signs?

Abdominal discomfort usually starts around your belly button, in the center of your abdomen. For several hours, it can hover or come and go. The discomfort eventually gets worse, and nausea and vomiting appear. After a few hours, the nausea subsides and the discomfort moves to your appendix, which is located in your lower right abdomen. The pain intensifies and becomes more focused.

What other symptoms of appendicitis could there be?

Additional symptoms may develop later in some people. These may consist of:

• Fever. Fever can strike up to 40% of the population. This indicates that your immune system is functioning at a higher level. Additionally, it could indicate a rise in inflammation or the spread of an infection.

• Malaise. You can simply notice that you don't feel well overall. You might feel like staying in bed, like you do when you're unwell, and lack motivation or energy.

• Swollen belly. Your belly may feel swollen or appear enlarged. This may be a sign of an appendix rupture and is typically an advanced symptom.

• Symptoms related to the urine.  You can experience an increased frequency or urgency of urination.  This may occur if your bladder's nerves are irritated by appendicitis.

•  Paralysis of the bowels.  Your bowels may momentarily stop moving when your body transfers blood flow from them to your appendix.  Constipation causes some people to feel as though they are unable to pass gas.  You could feel that your symptoms would go away if you had a bowel movement.

• Diarrhea.  Some people may poop more frequently due to hyperactive intestines.  This could be because the terminal part of your colon, next to your appendix is irritated by inflammation from it.

Why does appendicitis occur?

Because of its size and position, your appendix is susceptible to infection and blockage. Numerous bacteria live in your big intestine; if too many of them get stuck in your appendix, they can proliferate and infect you. Sometimes an infection is the initial cause of appendicitis, and other times the infection is subsequent. Your appendix's swelling may narrow or seal the entrance, trapping more bacteria inside.

The following are typical reasons for appendix inflammation, swelling, blockage, and infection:

• Appendix stones are hardened excrement. Fecaliths, appendicoliths, or appendix stones are hard, calcified fecal deposits that can become lodged in the appendix's orifice. In addition to carrying bacteria, they have can capture bacteria that were previously present in your appendix.

• Hyperplasia of the lymphoids. As a component of your immune system, the lymphatic system produces and releases white blood cells into your tissues to aid in the battle against infections. Even if the initial infection was elsewhere in your body, this can lead to swelling of the lymphoid tissue in your appendix. Your appendix's enlarged tissue may restrict it and cause an infection.

• Colitis. Your appendix may be affected by colon inflammation brought on by an infection or inflammatory bowel disease. Either the inflammation itself may aggravate it, or the infection itself may spread.

Further factors that could prevent your appendix from opening include:

• Cystic fibrosis, 
• Tumors
• Parasites.

What potential complications might appendicitis cause?

Because appendicitis can cause very dangerous consequences very fast, it is treated as an emergency by medical professionals. Although they don't usually happen that way, complications might develop in phases. Stages of complications may include:

• Necrosis and ischemia. Your appendix's severe enlargement stops the blood flow (ischemia), which increases inflammation and ultimately leads to the tissues' beginning to deteriorate (necrosis).

• Gangrene or puncture. Infection can spread when necrosis occurs. It can spread fast when your appendix breaks or bursts (perforation) or slowly through internal gangrene.

• Phlegmon or abscess. at first, the infection may not spread much outside of your appendix. On the outside of your appendix, it may develop into an abscess, or a pocket of pus. Additionally, a mass known as a phlegmon may form surrounding the appendix. The infection is contained in these lumps, but they may burst.

• Spreading infection and peritonitis. It can spread to other organs and even to your circulation (septicemia) when an infection enters your peritoneal cavity (peritonitis). Infection in your bloodstream can progress to sepsis and septic shock, which can be fatal.

How is a diagnosis of appendicitis made?

A medical professional will question you in-depth regarding your pain and other symptoms. To look for physical symptoms of appendicitis, such as guarding, stiffening, and pain when pressure is applied, they will do a mild physical examination. They might be able to diagnose you immediately if your symptoms fit the usual profile. They might have to order additional tests to confirm appendicitis if you don't.

Which tests are used to identify appendicitis?

Imaging and blood testing are commonly used to diagnose appendicitis. Blood tests can detect an infection and provide indicators of inflammation, such as a high C-reactive protein or white blood cell count. If your appendix is swollen, imaging procedures like a CT scan or abdominal ultrasound can reveal it. To rule out other conditions, a medical professional could prescribe more tests.

Treatment

Is it possible for appendicitis to resolve itself?

Though unlikely, it is conceivable. If the cause of appendicitis suddenly disappears on its own, it may resolve spontaneously. This could occur if an infection that was producing lymphoid hyperplasia in your appendix suddenly gets better or if an obstruction in your appendix becomes unstuck and moves through your intestine. Even if your discomfort has subsided, you shouldn't assume that this will occur or that it has.

How does one go about treating appendicitis?
Since appendicitis is seen as an emergency, it is treated in the ER. Although medicine may be sufficient in a few situations, the typical treatment consists of both medication and surgery.

Medications
For appendicitis, almost everyone will require antibiotics. Appendicitis typically causes an infection, even if you didn't have one in the first place. Before surgery, antibiotics are also a common preventive measure.

Your doctor may decide to wait and see if antibiotics alone can help if you have a very early and mild case of appendicitis. If you have risk factors that make surgery less safe for you, you might prefer this method. However, because appendicitis frequently recurs after appendix removal, doctors hardly ever advise it.

For pain relief, you might also require medication. This can be administered to you through an IV. You won't be conscious (awake) during surgery because you will be under general anesthesia.

Surgery

You have to act quickly after receiving an appendicitis diagnosis. Within 36 hours of the onset of your symptoms, your appendix may burst. Your appendectomy will often be scheduled by surgeons within 24 hours following your diagnosis. One of the most frequent surgical operations carried out globally is appendectomy. Laparoscopic surgery is one of the minimally invasive techniques that surgeons can frequently use to accomplish it.

Any issues that arise during the surgery will also be treated by your surgeon. To treat complications, open abdominal surgery might be necessary. Following surgery, a sterile solution will be used to rinse your abdomen.

The removal of your appendix has no negative repercussions. The function of your appendix is unknown to medical professionals. It will be a minor one if it does. During childhood, it might aid in the making of antibodies.

How long does it take to recover from an appendectomy?

You might be able to return home the same day after a straightforward laparoscopic appendectomy. You may need to stay in the hospital for a bit longer if you have open surgery or difficulties. During your first few days at home, you may require pain management. Most people recover completely in six weeks.

References:

• U.S. National Institute of Diabetes and Digestive and Kidney Diseases. Appendicitis (https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis). Accessed 5/9/2023.

• Kothadia JP, Katz S, Ginzburg L. Chronic appendicitis: uncommon cause of chronic abdominal pain (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416293/). Therap Adv Gastroenterol. 2015 May;8(3):160-2. Accessed 5/9/2023.

• Merck Manual Professional Version. Appendicitis (https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/appendicitis). Accessed 5/9/2023.

• Jones MW, Lopez RA, Deppen JG. Appendicitis (https://www.ncbi.nlm.nih.gov/books/NBK493193/). [Updated 2022 Oct 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 5/9/2023.

• Appendicitis. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis. Accessed April 5, 2023