Appendicitis is the inflammation of the appendix. The condition can be life-threatening if ignored and even more so if the appendix ruptures. While early symptoms can vary between age groups, they are often confused with symptoms of other conditions.
However, there are some key symptoms specific to those suffering from appendicitis and the quicker the diagnosis is made, the better. Read on to learn all you need to know about the condition, including diagnosis, best treatment options, and recovery times.
What is the Appendix?
The appendix is about four inches long and it’s located on the right, lower side of the abdomen. It’s a tube-shaped tissue that is closed at one end and is attached to the cecum, a pouch-like portion of the colon, or large intestine.
What is the Function of the Appendix?
The appendix serves an important role in the fetus and in young adults, with endocrine cells appearing in the appendix of the human fetus at around the 11th week of development. Those endocrine cells have been shown to produce biogenic amines and peptide hormones, compounds that assist with various biological control mechanisms. Among adults, the appendix is thought to be involved primarily in immune functions.
Role of Appendix in Developmental Years
Shortly after birth, lymphoid tissue begins to accumulate in the appendix and reaches a peak between the second and third decades of a person’s life. By the age of 60, it decreases rapidly and practically disappears. But, during the early years of development, the appendix has been shown to function as a lymphoid organ, assisting with the maturations of white blood cells and in the production of immunoglobulin antibodies.
The Gastrointestinal Tract
Research has also shown that the appendix is involved in the production of molecules that help to direct the movement of lymphocytes to other locations in the body. The function of the appendix appears to be to expose white blood cells to the variety of foreign substances present in the gastrointestinal tract. The appendix also helps to suppress potentially destructive antibody responses while promoting immunity, although its exact role is not clear.
What is Appendicitis?
Appendicitis happens when the appendix becomes inflamed and the symptoms can be painful, uncomfortable, and potentially life-threatening. In fact, sudden appendicitis is the most common cause of acute abdominal pain requiring surgery in the United States, with more than five percent of the population developing it at some point in their lives.
Causes for Appendicitis
Appendicitis typically occurs when either a stomach infection makes its way to the appendix, or a hard piece of stool becomes trapped in the appendix, causing an infection. The most common age to develop appendicitis is during the teenage years and in the 20s, although it can develop at any age. More than 250,000 appendectomies (surgical removals of the appendix) are performed in the United States each year.
First Signs of Appendicitis
Severe and sudden abdominal pain is usually the first symptom of appendicitis. This pain often begins near the belly button and as it worsens, it will likely shift to the lower right side of the abdomen. Usually, the feeling may become more intense over the next few hours and the pain worsens by moving around, coughing, sneezing, or taking deep breaths.
Symptoms of Appendicitis
Other classic symptoms of appendicitis are a loss of appetite, constipation or diarrhea, nausea, vomiting, low-grade fever and chills, stomach swelling, and an urge to defecate to relieve discomfort. However, these symptoms will only appear in half of cases, with some patients experiencing very slight stomach pain symptoms or none at all.
Symptoms in Children and Infants
Children and infants may experience tenderness throughout the body, or there may be no pain. They also may not experience pain in one specific area, making appendicitis hard to diagnose. Some children and infants may have less frequent or no bowel movements, and if diarrhea does occur, it may be a symptom of another illness.
Symptoms in Adults and Pregnant Women
Still, for children and infants, abdominal pain is the most common symptom of appendicitis. Older adults and pregnant woman may experience different symptoms — stomach pain that is less severe and specific. Other possible symptoms include fever, nausea, and vomiting. For women who are pregnant, the pain may shift upward toward the upper right quadrant after the first trimester.
Abdominal pain can also be a symptom of other conditions similar to appendicitis. These conditions include constipation, damage or injury to the abdomen, stomach lesions, parasites or growths clogging the appendix, or inflammatory bowel diseases, such as Crohn’s disease. Around half of all patients with appendicitis do not have typical symptoms, which makes it hard to diagnose.
Not everyone’s appendix is located in exactly the same place, and sometimes it’s located behind the liver, colon, or within the pelvis. A doctor will need to examine the patient and ask questions related to their symptoms to determine the diagnosis. The doctor may even apply pressure to the area to see if the pain worsens when touched. If the doctor detects typical signs and symptoms, they will diagnose the condition as appendicitis. If not, further tests will be ordered.
Tests to Diagnose Appendicitis
These tests include an MRI, CT, or ultrasound scans to see if the appendix is inflamed, blood tests to check for infection, and urine tests to identify a kidney or bladder infection. In some cases a doctor will decide to surgically remove the appendix immediately, because it is too risky to the patient to wait for tests to confirm a diagnosis.
If the infection is mild, antibiotics are used to treat appendicitis, although this is rare. The treatment begins with antibiotics and intravenous fluid, with the most common next step being an appendectomy. Removing the appendix decreases the risk of it rupturing and early treatment is vital to reduce the risk of complications.
One type of surgery is laparoscopic surgery, a procedure where surgeons make several small incisions and use special tools to remove the appendix. Laparoscopic, keyhole, or minimally invasive surgery involves a few steps. The first is involves the surgeon inserting a thin tube, which has a tiny camera and light, into the abdomen with an instrument known as a cannula.
During Laparoscopic Surgery
The surgeon can then view the inside of the abdomen on a monitor and tiny instruments moved by the surgeon’s hands, remove the appendix through small abdominal incisions. With this operation there is minimal loss of blood and as a result, recovery time is faster than with open surgery. There is also significantly less scarring with laparoscopic surgery.
However, in other cases, a larger incision is made so that the area outside the abdominal cavity can be cleaned. This will happen if the appendix has ruptured, an infection has spread, the appendix has caused an abscess, the patient has had abdominal surgeries before, or if the patient is a woman in her third trimester of pregnancy. After the operation is performed, the patient will be given antibiotics intravenously.
Recovering from Laparoscopic Surgery
In the case of keyhole surgery, the patient can usually go home after 24 hours, but for the first few days, there will usually be some discomfort. This includes constipation, pain, bruising, and there may also be pain at the tip of the shoulder since gas is pumped into the abdomen during the procedure. Over-the-counter painkillers will be administered to help with pain while the patient recovers.
Recovering from Open Surgery
If open surgery is needed, or if the patient experiences a complication, they may have to stay at the hospital for up to a week. It usually takes around two weeks to return to normal activities, and up to one month for more strenuous ones. With prompt treatment, appendicitis is treatable and recovery is fast and complete. Without surgery or antibiotics, the mortality rate can be 50 percent or higher, while with early surgery, the mortality rate is less than one percent.
Prevention of Appendicitis
The people of countries with lower incidences of appendicitis tend to have more fiber in their diets. It may be that a high-fiber diet helps reduce the chances of developing appendicitis in the first place. Fiber helps to create softer stools which makes them less likely to get trapped in the appendix. It’s best to be treated for appendicitis as quickly as possible to prevent any further complications.