Have you ever thought that inside your stomach, to be exact, on the right side of your large intestine, there is a small, pouch-like part about the length of a little finger? That's what we call the appendix . Usually, it doesn't bother us. But sometimes, if this appendix becomes swollen and infected, that's when a condition called appendicitis occurs. This can be a bit serious, so let's talk about it today.
Why is appendicitis such an emergency?
Simply put, appendicitis is an inflammation of your appendix. Imagine, if your feces , which travels down your large intestine, gets stuck in the mouth of this little appendix, or if some germ gets in and infects it, the appendix starts to swell. If this swelling increases, the appendix can burst! That's the most dangerous thing.
If the appendix bursts, all the germs inside it spread into the abdomen. We call this peritonitis . This infection can also spread to the blood and cause conditions like sepsis , which can be life-threatening. That is why the appendix is removed surgically (appendectomy) as soon as appendicitis occurs. The appendix is not an essential organ in our body, so you will not feel any loss after having it removed.
What are acute and chronic appendicitis?
Appendicitis is usually an acute condition. That means it starts suddenly and gets worse quickly. This is the type of appendicitis we talk about and see the most.
However, there is also a very rare type called chronic appendicitis . In this case, the appendix swells up a little bit for a long time, from time to time. But it does not get worse as quickly as in acute appendicitis. Therefore, it is sometimes difficult to diagnose. However, any type of appendicitis should be taken seriously. If you have persistent abdominal pain and do not know the cause, you should definitely see a doctor. Because chronic appendicitis can also become acute at any time. Therefore, doctors treat both in the same way.
How common is appendicitis?
Acute appendicitis is a very common condition , especially in people between the ages of 10 and 30. It is most common in young children, but it can also affect younger children. In countries like the United States, about 5% of people will develop appendicitis in their lifetime. It is the leading cause of emergency surgery for abdominal pain. Chronic appendicitis occurs in only a small percentage, about 1%.
What are the symptoms of appendicitis?
The main symptoms of appendicitis are abdominal pain, nausea, and loss of appetite . There is a specific pattern in which these symptoms appear, which makes it easy to recognize appendicitis. However, unfortunately, only half of people with appendicitis show these classic symptoms. These common symptoms can appear differently in young children, the elderly, and pregnant women.
The first symptoms of appendicitis
This is what usually happens:
1. First, a pain starts in the middle of the stomach, around the navel . This may last for a while and come and go.
2. After a few hours, the pain becomes more severe, and nausea and vomiting begin.
3. After a few hours, the nausea subsides and the pain moves to the lower right side of the abdomen , exactly where the appendix is. The pain is concentrated in one spot and continues to increase.
Other possible symptoms
Some people may later develop symptoms such as:
- Fever: About 40% of people may get a fever. This means that your body's immune system is starting to work. Or it could be that the swelling is increasing and the infection is spreading.
- Malaise: You may feel unwell, have no interest in anything, and feel like staying in bed. Just like when you are sick.
- Abdominal distension/bloating: Your abdomen may feel bloated or full. This is usually a less serious sign, and could be a sign that your appendix has burst.
- Urinary problems: You may feel like you need to urinate frequently or suddenly feel a need to urinate. This can happen if the nerves connected to the bladder are stimulated by appendicitis.
- Bowel paralysis: When blood flow to the appendix is diverted, bowel function may temporarily stop. Some people may experience constipation and difficulty passing air. They may feel that the problem will go away if they pass stool.
- Diarrhea: Some people may experience excessive bowel activity and frequent bowel movements. This may be due to the swelling of the appendix, which may also stimulate the adjacent large intestine.
Can you check for appendicitis at home?
If you suspect you have appendicitis, you should definitely see a doctor to get it checked out. However, there are a few signs that doctors use to help diagnose appendicitis. The location of the pain is very important. It's common for it to start in the lower right abdomen and move to the lower right side. However, some people may feel the pain in other places. Doctors look for things like:
- McBurney's sign: McBurney's point is where the appendix is usually located. If it hurts when you press on it, that's the first thing a doctor will look for. This point is found by drawing a line from your hip bone to your abdomen, about a third of the way down (about two inches) from that line.
- Blumberg's sign: Pain that increases when you press on the painful area and then remove your hand. This is also called rebound tenderness .
- Dunphy's sign: Pain that increases when coughing.
- Rovsing's sign: Pain on the right side of the abdomen when pressing on the left side.
- Psoas sign: If your appendix is behind (not in front of) your large intestine, appendicitis may be affecting your psoas muscle. You may then feel pain by bending your right hip. If a doctor tries to extend or rotate your right hip outwards, it is called the psoas sign . If it hurts when you rotate it inwards, it is called the obturator sign .
The most important thing: Even if you are aware of these signs, do not try to diagnose yourself. If you have unusual stomach pain, see a doctor immediately.
What other diseases can be confused with appendicitis?
Appendicitis symptoms can be similar to many other conditions, especially in women. Because your lower abdomen is close to your pelvic cavity, conditions that affect your pelvic organs can feel similar to appendicitis. These organs include your urinary system and female reproductive system. Other lower abdominal organs can also be affected.
Some diseases that can easily be confused with appendicitis are:
- Pelvic inflammatory disease (PID)
- Endometriosis
- Ovarian cyst
- Kidney stone
- Urinary tract infection (UTI)
- Pancreatitis
- Inflammatory bowel disease (IBD)
- Diverticulitis of the colon
- Gastroenteritis (intestinal tract infection)
- Intestinal obstruction
What are the causes of appendicitis?
Because of the size of the appendix and the way it's located, it can easily become blocked and infected. Your large intestine is home to a lot of bacteria. If too many of these bacteria get stuck inside the appendix, they can multiply and cause an infection. Sometimes appendicitis starts with an infection, and sometimes the infection is secondary. When the appendix swells, its opening can close, allowing more bacteria to get stuck inside.
Some of the main causes of swelling, blockage, and infection of the appendix are:
- Appendix stones / Fecaliths / Appendicoliths: Hard, calcium-rich pieces of stool (also called fecaliths or appendicoliths ) can become lodged in the appendix. They contain bacteria and can also trap bacteria that are already inside.
- Lymphoid hyperplasia: The lymphatic system, which is part of your immune system, produces white blood cells and releases them into your tissues to fight infection. This can cause the lymph nodes in your appendix to swell, even if there is an infection elsewhere in your body. This swollen tissue can block the appendix and cause an infection to develop inside.
- Colitis: Inflammation of the colon , whether caused by an infection or a condition like IBD , can affect the appendix. The infection can spread, and the inflammation can irritate the appendix.
Other possible causes of a blocked appendix include:
- Tumors
- Parasites
- Cystic fibrosis
Why does chronic appendicitis occur?
The idea behind chronic appendicitis is that something causes a small amount of inflammation over a long period of time. It could be a long-term condition like IBD , or it could be a small bacterial overgrowth. Or it could be a blockage in the appendix that gets stuck and then comes back. Long-term inflammation can lead to lymphoid hyperplasia , or over time, scar tissue in the appendix.
Is appendicitis hereditary?
If someone in your family has had appendicitis, you may be at slightly higher risk of developing it too. But the exact cause is not clear. Appendicitis itself is not hereditary, but some of the factors that cause it may have a genetic influence.
Can stress cause appendicitis?
The chances of this happening are very low. However, severe physical stress caused by serious illness can cause reduced blood flow to the intestines (bowel ischemia) . This condition , called ischemic colitis, can rarely affect the appendix.
Can food cause appendicitis?
There have been rare reports of an indigestible seed or nut getting stuck in the appendix, causing swelling. However, in general, a high-fiber diet reduces the risk of appendicitis.
What are the possible complications of appendicitis?
Appendicitis can quickly lead to very serious complications . That's why doctors treat it as an emergency. Complications can get worse over time, but they don't always happen in the same way.
Complications (stages) can be like this:
- Reduced blood flow and tissue death (Ischemia and necrosis): Severe swelling of the appendix causes the blood supply to it to stop (ischemia) , causing further swelling, and eventually the tissue to begin to die (necrosis) .
- Gangrene/perforation: When tissue begins to die, the infection can spread. It can spread internally as gangrene , or it can spread rapidly through a rupture or perforation of the appendix.
- Abscess/phlegmon: Initially, the infection may not spread beyond the appendix. It may develop as an abscess outside the appendix. Or a lump called a phlegmon may form around the appendix. These lumps may contain infection, but they can burst.
- Peritonitis and spreading infection: When the infection spreads to the lining of the abdominal cavity (peritoneal cavity - peritonitis) , it can spread to other organs and eventually to the bloodstream (septicemia) . If the infection spreads to the bloodstream, it can cause conditions such as sepsis and septic shock , which can be life-threatening.
How is appendicitis diagnosed?
A doctor will ask you about your pain and other symptoms. They will do a careful physical exam and look for physical signs of appendicitis (for example, pain when pressing on your abdomen, a hard lump in your abdomen). If you have the typical symptoms, they will be able to diagnose the condition quickly. Otherwise, they will need to do more tests to confirm appendicitis.
What tests are used to diagnose appendicitis?
Appendicitis tests usually include blood tests and imaging tests. Blood tests can show signs of inflammation (such as an increased white blood cell count and C-reactive protein ) and can help diagnose an infection. Imaging tests, such as an abdominal ultrasound or CT scan, can show if the appendix is swollen. A doctor may also order additional tests to rule out other conditions.
Can appendicitis get better on its own?
It is possible, but it is very unlikely. If the cause of appendicitis suddenly disappears, it may resolve on its own. For example, if something stuck in the appendix passes through the intestine, or if an infection that caused swollen lymph nodes suddenly resolves. However, don't assume that this will happen, even if the pain subsides.
What are the treatments for appendicitis?
Because appendicitis is an emergency, it is treated in the emergency room. The usual treatment includes both medication and surgery. However, in very rare cases, medication alone may be sufficient.
Medication
Almost everyone with appendicitis will need to be given antibiotics . Even if you don't have an infection to begin with, appendicitis usually causes an infection. It's common to be given antibiotics before surgery to prevent infection.
If you have a very early, mild case of appendicitis, your doctor may decide to just give you antibiotics and watch your symptoms. If you are at high risk for surgery, you may want to consider this option. However, doctors rarely recommend this option because if the appendix is not removed, the chance of the appendicitis coming back is high.
You may also need pain relief . This can be given through an IV (saline given into a vein in your arm) . If you are having surgery, you will be given general anesthesia , so you will not be conscious during the surgery.
Surgery
Once you’re diagnosed with appendicitis, time is of the essence. Your appendix can burst within 36 hours of your first symptoms. Surgeons usually schedule an appendectomy within 24 hours of your diagnosis. Appendectomy is one of the most common surgeries performed worldwide. Surgeons can often do it with minimally invasive techniques, such as laparoscopic surgery . That is, surgery that involves making just a few small incisions in the abdomen and inserting a camera and delicate instruments.
If you have any complications, the surgeon will treat them during the surgery. If there are complications, you may need to have open abdominal surgery . After the surgery, they will wash and clean the inside of your abdomen with a sterile solution.
There are no side effects after removing the appendix. Doctors aren't even sure if the appendix does anything. If it does, it's very small. Maybe it helps make antibodies during childhood.
How long does it take to recover after an appendectomy?
If you had a simple laparoscopic appendectomy, you may be able to go home the same day. If you had complications, or if you had open surgery, you may need to stay in the hospital for a few more days. You may need pain medication for the first few days after you go home. Most people recover completely in about six weeks.
What is the outlook for this situation?
If caught and treated early, the outlook is very good. Most people recover quickly and completely. If you have had complicated appendicitis, your recovery time may be a little longer. You may need to get repeated treatments for infections that have spread beyond the appendix. Appendicitis treated with antibiotics alone has a 40% risk of recurrence. Untreated appendicitis has a 50% risk of death.
When should you seek medical advice for appendicitis?
Appendicitis is always an emergency!
If you have any of these symptoms or signs of appendicitis, seek medical advice immediately:
- Pain in the lower right side of the abdomen.
- If the stomach pain is gradually increasing.
- If you have nausea and/or fever along with stomach pain.
- If it hurts when you press on your stomach or put your hand on it.
You probably never think about your appendix until it hurts one day. If that happens, there's no time to wait around – you need to go to the hospital right away. Appendicitis is serious, but it's common. If you need emergency surgery, you're in experienced hands. Once this is over, you'll never have to worry about appendicitis again.
Things we should remember from this story (Take-Home Message)
Okay, so let's recap the most important things we talked about:
- Appendicitis is an emergency. If you have symptoms like severe pain in the lower right side of your abdomen, nausea, and fever, it could be appendicitis.
- Don't waste time. If you have symptoms, see a doctor right away. Because it doesn't take long for an appendix to burst.
- There are treatments. The most common procedure is to remove the appendix surgically (appendectomy) . This is often done through small incisions (laparoscopic) .
- It can be cured. If you get treatment quickly, you can recover completely and return to a normal life.
- Don't panic, but be vigilant. It's important to be aware of appendicitis. Take action as soon as you suspect symptoms.
I hope you find this information useful. Stay healthy!
` Appendicitis, stomach ache, appendix, abdominal pain, appendectomy, emergency surgery, peritonitis
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