Introduction
Acute inflammation of the appendix and acute appendicitis is the most common acute abdominal condition confronting the surgeon. The condition is seen more commonly in older children and young adults and is uncommon at the extremes of age. The disease is seen more frequently in affluent societies, which may be due to variation in the diet - a diet with low bulk or cellulose and high protein intake causing appendicitis.
What Is Appendicitis?
Inflammation is the local response of the living tissue to injury from any agent, which could be microbial, immunological, physical, or chemical agents. The sign of inflammation is redness, swelling, heat, pain, and loss of function. Appendicitis is the inflammation of the appendix, a structure situated in the lower right side of the abdomen. Acute inflammation is due to the early response by the body and is of short duration.
Appendicitis causes pain in the lower abdomen. It is easily treatable but can have dangerous consequences if left untreated. In addition, the person should not ignore the pain in the lower abdomen, though the pain could be due to many reasons. Pain worsens if it is left untreated. The treatment of appendicitis is surgery and antibiotics for acute appendicitis.
What Are the Causes of Appendicitis?
The common causes of appendicitis are:
Obstructive Causes:
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Calculi - An abnormal deposition of mineral salts in the form of stones in the urinary or biliary tract, such as gallstones or kidney stones.
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Foreign Body - The insertion of a foreign body in the appendix can cause swelling, irritation, and pain in the lower abdomen.
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Tumor - An abnormal tissue growth in the nearby appendix can cause inflammation.
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Worms - Especially Enterobius vermicularis, a parasite, including sea worms, pinworms, and threadworms which feed on the human host and cause infection.
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Diffuse Lymphoid Hyperplasia - It is an uncommon disease characterized by multiple small polypoid nodules developing in the large and small intestines, especially in children.
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Fecalith - A stone made up of feces is called fecalith. It is a lump of feces that can occur in various sizes and is found anywhere in the intestinal tract, but if found in the appendix, it is called appendicolith.
Non-obstructive Causes:
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Hematogenous (Originating or Carried Through the Blood) Spread of Generalized Infection - In certain diseases, bacteremia can spread to distant organs through blood.
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Vascular Occlusion - The blockage of the blood vessel due to a clot or foreign body can obstruct the blood supply to the appendix, resulting in inflammation.
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Inappropriate Diet - The current trend is to consume a Western diet and highly pre-packaged foods. High consumption of red meat, processed meat, fried food, high-sugar drinks, and butter can lead to appendicitis. Several studies show that intake of low-fiber food or a diet lacking in roughage can obstruct defecation and cause appendicitis.
What Are the Symptoms of Appendicitis?
The patient presents with the feature of the acute abdomen as:
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Colicky pain, initially around the umbilicus, but later localized to the right abdomen.
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Nausea and vomiting.
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Pyrexia (fever) of mild grade.
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Abdominal tenderness.
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Irritation in the abdomen.
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Severe abdominal pain during movements, such as walking or coughing.
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Loss of appetite.
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Constipation.
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Indigestion.
Signs:
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Increase pulse rate.
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Neutrophilic leukocytosis (elevated white blood cells in the blood).
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Abdominal tenderness on palpation.
What Are the Complications of Appendicitis?
If the condition is not adequately managed, the following complication can occur:
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Peritonitis - As gangrenous appendicitis occurs, a perforated appendix may cause localized or generalized peritonitis.
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Appendix Abscess - This is due to the rupture of an appendix giving rise to the localized abscess in the right lower abdomen. The abscess may spread to other areas, like the space between the liver and the diaphragm (subphrenic abscess) or between the urinary bladder and the rectum. In females, it may involve the uterus and fallopian tubes.
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Adhesions - Late complications of acute appendicitis are fibrous adhesion to the greater omentum, small intestine, and other abdominal structures.
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Portal Pylephlebitis - The spread of infection into the mesenteric vein may produce septic phlebitis and liver abscess.
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Mucocele - Distension of the appendix by mucus is referred to as mucocele. During recovery from acute appendicitis, mucus is secreted and collected in the appendix leading to swelling. It is generally due to the proximal obstruction, but some time may be due to benign or malignant neoplasm in the appendix. An infected mucocele may result in the formation of empyema of the appendix (collection of pus in the appendix).
When to See a Doctor?
Appendicitis is a medical emergency, and if diagnosed with one should not be ignored. Immediate hospitalization is needed if the person is suffering from severe abdominal pain. For example, if a person suffers from constipation or feels tenderness in the right lower abdomen and cannot pass gas, they should consult a doctor immediately.
What Is the Treatment of Appendicitis?
The general approach is to close perforation, treat the inflammatory condition with antibiotics and relieve obstructions.
The treatment summary of appendicitis is as follows:
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Surgery - The process of removing the appendix by surgical intervention is called appendicectomy. The necessity of surgery depends on the organ and many other factors. The appendix can be removed through conventional surgery by an incision in the right lower abdomen or by laparoscopic techniques. If appendectomy is done at a later stage following the acute attack, chronic inflammation of the appendix is observed. An attack of acute appendicitis predisposes the appendix to repeated attack (recurrent acute appendicitis). Therefore, surgery must be carried out.
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Antibiotics - Antibiotics can treat uncomplicated appendicitis and acute appendicitis.
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Metronidazole can be given orally.
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Ceftriaxone is administered once daily intravenously.
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Cefepime.
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Amoxicillin can be given orally as it has better oral absorption than Ampicillin.
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Fluoroquinolones.
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Painkillers.
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What Is the Success of Antibiotics for Appendicitis?
Studies have shown approximately a 70 percent success rate of antibiotics for appendicitis. Uncomplicated appendicitis and acute appendicitis can be treated by antibiotics alone. However, the combination of intravenous injection and antimicrobial drugs is proven effective in several hospital patients.
Ceftriaxone injection is administered intravenously. Antibacterial drugs follow it, like Amoxicillin, Sulbactam, Metronidazole, and Fluoroquinolones, given orally for eight to fifteen days in uncomplicated appendicitis.
An experiment on over 900 uncomplicated appendicitis treated with antibiotics shows a successful result in around 70 percent of patients. After one year of follow-up, about 78 percent of patients did not need rehospitalization; their symptoms disappeared without relapse. In early practice, only surgery was the treatment of choice, but now the proper administration of antibiotics is also helpful these days.
Patients can take several months to get fully cured, which may take longer if they suffer complications. The recovery of appendicitis depends on the patient:
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Age - As old age has a slow recovery or healing process.
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Overall Health - Patients’ overall health matters for recovery as they get proper instruction after the surgery or before leaving the hospital. A doctor may prescribe pain relievers and antibiotics.
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Complications - Recovery of appendicitis depends on the severity of the disease.
Conclusion
There are no sure ways to prevent appendicitis. However, one can still avoid it by consuming a high-fiber diet, including pulses, brown rice, roughage, yogurts, cereal, fruits, green vegetables, and properly cooked foods. One should avoid frequent consumption of fast food or packaged foods. People should drink plenty of water and start their day with a morning walk to keep themselves healthy.
