What is appendicitis?
Dear Mirror Doctor, I went to work very healthy. At mid-day, I started experiencing some severe abdominal pains. Initially I ignored the pains because I thought it was cramps but around evening I could hardly move as the pain had become unbearable.
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I was sent to the hospital and to my rudest shock, I was diagnosed with appendicitis. I had surgery done and my appendix was sent to the pathologist who also confirmed appendicitis.
Please Doctor, what is appendicitis and how can it be prevented? Is there any risk of recurrence?
Kofi O. Wusu, Kumasi
Dear Wusu, The appendix is a closed-ended, narrow tube up to several inches in length that attaches to a part of the large intestine called caecum. The open central core drains into the lumen of the large intestine.
The inner lining of the appendix produces a small amount of mucus that flows through the open central core of the appendix and into the intestine.
The wall of the appendix contains structures (lymphoid or lymphatic tissues) that form part of the immune system for making antibodies.
Appendicitis means inflammation of the appendix. It is thought that appendicitis begins when the opening from the appendix into the intestine becomes blocked.
The blockage may be due to a build-up of thick mucus within the appendix or stool that enters the appendix. The mucus or stool hardens, becomes rock-like, and blocks the opening. Sometimes, the blockage is from enlargement of the lymphoid tissues.
After the blockage occurs, bacteria which normally are found within the appendix begin to infect the wall of the appendix. The body responds to the invasion by mounting an attack on the bacteria, a process called inflammation.
An alternative theory for the cause of appendicitis is an initial rupture of the appendix followed by spread of bacteria outside of the appendix.
The cause of such a rupture is unclear, but it may relate to changes that occur in the lymphatic tissue that lines the wall of the appendix.
Sometimes, the body is successful in healing the appendicitis without treatment if the infection and accompanying inflammation do not spread throughout the abdomen. This is particularly true in elderly patients and when antibiotics are used.
The main symptom of appendicitis is abdominal pain. The pain is at first generalised, not confined to one spot. A second, common, early symptom of appendicitis is loss of appetite which may progress to nausea and even vomiting.
As the inflammation increases, it extends to the outer covering and then to the lining of the abdomen, a thin membrane called the peritoneum.
Once the peritoneum becomes inflamed, the pain changes and then can be localised clearly to one small area, usually from the navel to the right flank.
If the appendix ruptures and infection spreads throughout the abdomen, the pain becomes diffused again as the entire lining of the abdomen becomes inflamed.
Raised white blood cells and a swollen appendix on ultrasound give the diagnosis away but mostly diagnosis is made from the clinical picture.
It can sometimes be difficult to diagnose appendicitis because the position of the appendix in the abdomen may vary. The diagnosis of appendicitis also can be difficult because other inflammatory problems may mimic appendicitis.
Once confirmed, the management is through surgical removal of the appendix to avoid complications of the disease. There is no risk of recurrence after removal of the appendix.
The most frequent complication of appendicitis is perforation. The major reason for perforation is delay in diagnosis and treatment. In general, the longer the delay between diagnosis and surgery, the more likely is perforation.
The risk of perforation 36 hours after the onset of symptoms is high. Therefore, once appendicitis is diagnosed, surgery should be done without unnecessary delay.
A less common complication of appendicitis is blockage or obstruction of the intestine. Blockage occurs when the inflammation surrounding the appendix causes the intestinal muscle to stop working, and this prevents the intestinal contents from passing.
If the intestine above the blockage begins to fill with liquid and gas, the abdomen distends and nausea and vomiting may occur.
Unfortunately, there is no known preventive measure from appendicitis.
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A member of Paediatric Society of Ghana
