Friday, January 18, 2008

Appendicitis: Not as bad as it sounds

By Dr Ajay Gupta, MS (General Surgeon)
Sunday, January 13th 2008

Appendicitis is a common and urgent surgical illness with different manifestations. It mimics other belly illnesses causing significant complications which increase with diagnostic delay. No single sign, symptom, or diagnostic test accurately confirms the diagnosis of appendicitis in most cases. Many of us experience belly pains that come and go but if you have pain in the lower right side of your abdomen, it may be appendicitis.
Appendicitis can sometimes be confused with other belly pain, but if you experience it with fever or nausea, consult a physician immediately. Getting medical care before the appendix bursts is important, as such a condition can be fatal.
What is an appendix?
The appendix is a small, finger or worm-shaped projection attached to part of the large intestine on your right side with no known function. It is believed the appendix had a specific purpose at some point in evolution, but we don't know what it is.
How does it get inflamed?
Obstruction of the appendix is the primary cause of appendicitis. The appendix becomes inflamed when a piece of stool lodges in it, or when its lymph tissue - (the tissue that produces a fluid containing white blood cells) - enlarges due to infection, especially viral. When this happens, the fluid that pours into the appendix becomes infected, causing appendicitis.
What are the symptoms?
Pain around the navel is usually the earliest symptom. You'll probably have no appetite and may feel nauseated. As the infection progresses, the pain becomes more severe. You may feel feverish and the pain may move to the lower right part of the abdomen as inflammation spreads. Pain may subside briefly, and then become generalized and very severe. If you don't seek treatment, the appendix may burst, spreading infected fluid into the abdomen.
What is the treatment?
There is no way to prevent appendicitis. While mild cases may resolve without treatment, most require removal of the inflamed appendix. The surgical procedure for the removal of the appendix is called an appendicectomy (also known as an appendectomy). Often now the operation can be performed via a laparoscopic approach, or via three small incisions with a camera to visualize the area of interest in the abdomen. If the findings reveal appendicitis with complications such as rupture, abscess, adhesions, etc, conversion to open surgery may be necessary. An open laparotomy incision, if required, most often centres on the area of maximum tenderness in the right lower quadrant. A transverse or a diagonal incision is used most commonly.
Laparoscopic appendectomy has the advantage of thorough exploration if the appendix is found to be normal, less hospital stay and early return to work; in addition the results are more cosmetic. If the appendix is removed in the early stages of pain, you can be discharged from the hospital after a few days with little chance of serious complications. The risk of complications is greater from a ruptured appendix because infected fluid spreads into the abdomen. Your physician probably will prescribe medication following surgery. Recovery can take two to four weeks.
Are there any complications from surgery?
Wound infection
Poor healing of the wound
Bowel obstruction
Pus in the belly
Death (rare) due to ruptured appendix with infection spreading into the body
Most appendicitis patients recover easily with treatment, but complications can occur if treatment is delayed.
The time needed for recovery depends on age, condition, complications, but usually is between 10 and 28 days. For young children (around 10 years old) the recovery takes three weeks.
The possibility of life-threatening peritonitis (infection in the belly) is the reason why acute appendicitis warrants speedy evaluation and treatment. Typical acute appendicitis responds quickly to appendectomy and occasionally will resolve spontaneously. Prompt diagnosis and appendectomy yield the best results with full recovery in two to four weeks usually. Death and severe complications are unusual but do occur, especially if peritonitis persists and is untreated.
Important points to note about appendicitis
Appendicitis is essentially a clinical diagnosis so even if your ultrasound/x-ray are normal you may still have appendicitis.
Diagnostic laparoscopy should be considered particularly in young women (perforation may cause infertility in girls later in life, and so there is a lower threshold for surgery in girls).
Appendicitis in pregnancy needs aggressive treatment and surgery remains the treatment of choice, because removal of a normal appendix does not affect maternal and foetal health as adversely as the perforated appendix.
Appendicitis is difficult to diagnose in elderly and younger children, and the index of suspicion should be high. These patients should be kept in the hospital under observation and surgery should be performed in case of the deterioration of the patient.
Appendicitis is not as bad a condition as it sounds, as long as timely intervention is done. However, delays in treatment can be fatal.

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