Appendicitis

Appendicitis is an inflammation of the appendix which is a worm like organ in the gut situated just below where the small bowel opens in to the large bowel. It is caused by bacterial infection from the intestinal contents.

• What is appendicitis?
• How does it occur?
• What are the symptoms?
• How is it diagnosed?
• How is it treated?
• Can it be prevented?

What is appendicitis?

 Appendicitis is an inflammation of the appendix which is a worm like organ in the gut situated just below where the small bowel opens in to the large bowel. It is caused by bacterial infection from the intestinal contents.

How does it occur?

 Infection by bacteria in the intestinal content set off a reaction, which causes swelling of the organ and frequently this blocks the organ's opening into the gut. Frequently it could be a small faecal lump that blocks the mouth, setting off an inflammatory reaction causing further swelling. Rarely parasites like worms could be responsible for such blockage.

What are the symptoms?

 The main symptom is pain in the abdomen, which classically begins around the umbilicus and soon settles in the right lower quadrant, just above the groin. This is associated with ill health, like fever that can be high and associated with sickly feeling and vomiting.

The area above the right groin will be very tender and the patient will object to touching the area; if left unrecognised the inflammation spreads to the overlying covering called peritoneum, causing generalised tenderness and pressing on the left side causes pain at the site of appendix.

Not infrequently appendicitis starts slowly as vague pains coming and going, and can be difficult to diagnose. It also can be very serious as the swollen organ can burst with the pressure inside, causing perforation and peritonitis, which are serious complications.

How is it diagnosed?

 A doctor should be consulted immediately. The diagnosis is made by the clinical history and doctor's examination. The blood check will show a high white cell count and a raised ESR or CRP - all signs of acute infection. Ultrasound can be useful, so are other tests like X-rays.

If diagnosis is delayed, a swelling forms around the area, when the organ is perforated, as a reaction of body's defense. Perforation if restricted by the formation of a local mass. It becomes serious i.e. perforation, if it spreads to the whole abdomen.

How is it treated?

 It is important that a doctor in the local hospital is consulted. Appropriate antibiotics are routinely used and when the patient settles he would need surgery, which is the corrective treatment. Surgery depends upon the seriousness of the patent’s presentation; i.e., if the patient shows signs of perforation he/she would need intensive therapy with antibiotics to help settle the condition and surgery carried out at a later date electively. Recently endoscopic surgery is being carried out at most hospital centres, but conventional procedure is still used universally.

Can it be prevented?

 No; there is no preventative treatment, but it should be realised that inadequate and wrong antibiotic therapy will help to mask inflammation, which will continue with recurring symptoms, sometimes referred to as "grumbling appendix". It should also be realised that appendicitis is said to be rare in the very young and the very old.