What is Acute Appendicitis?

Appendicitis is the swelling and inflammation of the appendix, a small, tube-shaped structure attached to the caecum, part of colon and located in the lower right abdomen. This acute condition usually starts as pain around the navel that then moves to the lower right side of the abdomen. As this inflammation advances, the pain grows and can get severe in nature. Although anyone can develop appendicitis, it is most common in people between the age group of 10 to 30 years of age. Treatment usually consists surgical removal of appendix along with antibiotics.

Symptoms of Appendicitis

Appendicitis has various symptoms, such as:

• Intense, stabbing pain usually begins on the lower right side of the abdomen.
• Early pain that might start around the navel and eventually move to the lower right side of abdomen.
• More pain during actions like coughing or walking.
• Associated nausea with vomiting.
• Decreased appetite.
• Mild fever that could become high-grade with progress.
• Change in bowel habits, such as constipation or diarrhoea.
• Bloating in the abdominal region.
• Accumulation of gas in abdomen.

The location of the pain may vary depending on a person’s age and position of their appendix. For example, in pregnancy, the pain can be higher in the abdomen because the appendix has moved upward duet to displacement of intestines by growing baby inside the Uterus.

When to meet a Surgeon?

Make an appointment with a health care provider if you or your child have worrisome symptoms. Extreme abdominal pain requires immediate medical attention.

Causes

Appendicitis is typically caused by an obstruction of the lumen, the inside of the appendix. Blocking appendix opening can trigger an infection, which causes bacteria to multiply rapidly. As the bacteria continue to grow, the appendix becomes angry, swollen and filled with pus. If not treated right away, an appendix can burst and can spread infection all over the abdomen.

Risk Factors

Factors that may make you more likely to develop appendicitis include:

• Age: Appendicitis can happen at any age, but it’s most common in people between the ages of 10 and 30.

• Gender: Males have an increased risk of experiencing appendicitis compared to females.

Complications of Appendicitis

Complications of appendicitis can be life-threatening, including:

–Ruptured Appendix: If the appendix ruptures, infectious material escapes into the abdomen, resulting in a critical condition called peritonitis. This can be life-threatening and requires emergency surgical treatment to remove the appendix and clean the infected area.

Abscess (Collection of pus): If the appendix breaks open, it can create an abscess, a localized site of pus within the abdomen. Usually, a surgeon places a tube through the abdominal wall to drain the abscess. This tube stays in place for a couple of days or weeks, and patients generally receive antibiotics to clear the infection.

Appendicular Mass needing Interval Surgery: This is usually done after the infection has resolved, the appendicular mass subsided with antibiotics. Then removal of appendix planned usually 6 to 8 weeks after the initial pain attack. 

Appendicular abscess drainage and Appendicectomy-If the condition allows, the surgeon may drain the abscess and remove the appendix in the same surgery.

Diagnosis

The diagnostic evaluation for appendicitis starts with the surgeon’s history taking and abdominal examination.

A diagnosis may involve the following steps:

Physical Exam: The healthcare provider may lightly press on the sore spot. Interestingly, if pressure is applied and pain is felt but then pressure is suddenly released, the pain may worsen, often suggesting inflammation of the peritoneum, the tissue lining the cavity of the abdomen.

Guarding: The examiner may also check for abdominal rigidity and observe if the patient tenses their abdominal muscles involuntarily, known as guarding, when pressure is applied to the inflamed area.

Digital Rectal Examination: A doctor can do a digital rectal exam by inserting a lubricated, gloved finger in the lower rectum. For those who are able to bear children, a pelvic examination may be performed to exclude other causes of the pain.

Blood Test: This examination checks for high levels of white blood cells, as a high count means there is an acute infection in part of the body.

Urinalysis: A urinalysis may be performed to look for urinary tract infections or kidney stones that can cause abdominal pain.

Imaging Studies: Imaging studies like abdominal X-rays, ultrasound of abdomen, CT scan abdomen with contrast or MRIs can help confirm appendicitis diagnosis or non-appendicitis source of the pain.

Appendicitis Treatment Plan-

A detailed history and physical examination are often enough to make a diagnosis of appendicitis, but imaging studies (ultrasound, CT scan, or MRI) may be used. Antibiotics may be given before the tests to treat existing infections.

Surgical Approaches-

There are two types of appendectomies they can perform:

Open Surgery (Laparotomy) – This standard method entails creating one large incision in the lower abdomen, which is typically 2 to 4 inches in width.

Laparoscopic Surgery: Laparoscopic surgery is a minimally invasive procedure that involves a few small incisions through which specialized instruments, and a video camera are inserted to aid in the removal of the appendix.

In general, laparoscopic surgery offers faster recovery and less pain and scarring, so it is often the method of choice, in particular for older and obese patients. But this will not necessarily be the right option for everyone — meaning open surgery might be needed if the appendix is ruptured and the infection has spread, or there is an abscess. In such instances, an open appendectomy provides the surgeon with improved access to irrigate the abdominal cavity.

Care after the Operation-

Patients typically spend 1 to 2 days in the hospital for monitoring and recovery and are discharged after an appendectomy.

Managing Complications-

If an abscess has formed because the appendix ruptured, it might have to be drained before the appendectomy is done. This is done by inserting a tube through the skin and into the abscess within the abdomen. Once the infection has been treated with antibiotics, the actual appendectomy can be planned for a few weeks later.

It is enough for non-complicated appendicitis, which does not require surgical intervention, if antibiotics only. With that said, avoiding surgery comes with an increased risk of recurrent appendicitis.

After an Appendectomy: Lifestyle and Home Care

If you were undergoing an appendectomy, recovery from the operation normally takes a few days to weeks, and in case your appendix ruptured (burst), it may take longer to heal. Here are tips to help you on the road to recovery:

Cut Down on Physical Activity: Please note that if your surgery was laparoscopic, you may want to avoid strenuous activity for 3 to 5 days. For an open appendectomy, plan to avoid normal activity for 10 to 14 days. Always follow your operating surgeon’s guidelines on activity limitations and resuming daily life.

For Protected Coughing: To ease the pain associated with coughing (or laughing or moving), place a pillow against your abdomen and push with gentle pressure.

Pain management: If your pain medications are not controlling your pain, contact your health care team. Chronic pain can slow your recovery, so be sure to address any concerns you have.

Ambulation: As soon as you’re able, start to get up and move about, with limited initial activity and progressively more as tolerated.

Seek Rest: You may find yourself exhausted more than you normally would now as the body heals. Rest whenever you’re feeling tired, always listen to your body. Take sick leave and give rest to your body.

Resuming Normal Activities: Talk with your health care provider about when you can return to work or school. While many children can go back to school in a week, other activities, like gym or sports, should be avoided for 2 up to 4 weeks to provide enough time for proper recovery.

Your doctor will give you medications to help your pain after your appendectomy. Aside from medications, a range of adjunctive therapies can improve your comfort. You might want to talk with your health care team about safe ways to do any of the following:

Do something you love, such as listening to music or talking with loved ones, to shift your attention from the pain. This method works especially well for younger patients.

By meditating, you help relax your body and have some time for you. Being well-rested is also important for the recovery process.

Preparing for Your Appointment for Your Abdominal Pain?

If you’re experiencing any abdominal pain, it’s imperative to contact your physician and schedule an appointment. For appendicitis, it often means going to the hospital and being referred to a surgeon for an appendectomy.

How to Prepare?

Ask if any special preparations are needed prior to your appointment, such as fasting for certain tests. You may find it helpful to prepare a list that consists of:

A description of your symptoms — even ones that don’t seem relevant to your visit.

Key personal details, like current stressors, major changes in your life, and your family’s medical history.

– A list of all medications, vitamins and supplements you are taking, and at what dosages.

If you can, take a family member or friend with you; they can help you keep track of the information you’re given.

Key Questions to Ask Your Doctor About Appendicitis

Here are some questions that may be helpful to ask during your consultation:

• Am I guaranteed to have appendicitis?
• Are additional tests going to be required?
• What are other likely causes for my symptoms?
• Do I need surgery, and when?
• What are the possible risks of the surgery?
• What is the average length of hospital stay following the procedure?
• How long will you need to recover?
• When can I return to my job after the surgery?
• Can you tell if my appendix has burst?

Do not hesitate to share with me anything else that you are confused about.

What Should You Ask Your Doctor

During your visit, your doctor will likely ask a series of questions about your condition, including:

• How long had you been experiencing abdominal pain?
• Can you identify where the pain is located?
• Is the pain moving to other locations?
• On a scale of 1-10, how bad is your pain?
• What makes your pain or condition worse?
• What (if anything) helps alleviate it?
• Have you had a fever?
• Are you feeling nauseous?
• Are there additional symptoms that you experience?