Appendicitis: Symptoms, Causes,Diagnosis, Pain, Surgery, Recovery and Treatment

Appendicitis Symptoms, Causes, Pain, Surgery, Recovery and Treatment

What is the appendix?

Appendicitis is an inflammation of the appendix, a 3 1/2-inch-long tube of tissue that extends from the large intestine. No one is absolutely certain what the function of the appendix is. One thing we do know: We can live without it, without apparent consequences.
Appendicitis: Symptoms, Causes, Pain, Surgery, Recovery and Treatment

Appendicitis is a medical emergency that requires prompt surgery to remove the appendix. Left untreated, an inflamed appendix will eventually burst, or perforate, spilling infectious materials into the abdominal cavity. This can lead to peritonitis, a serious inflammation of the abdominal cavity's lining (the peritoneum) that can be fatal unless it is treated quickly with strong antibiotics.

Sometimes a pus-filled abscess (infection that is walled off from the rest of the body) forms outside the inflamed appendix. Scar tissue then "walls off" the appendix from the rest of the abdomen, preventing infection from spreading. An abscessed appendix is a less urgent situation, but unfortunately, it can't be identified without surgery. For this reason, all cases of appendicitis are treated as emergencies, requiring surgery.

In the U.S., one in 15 people will get appendicitis. Although it can strike at any age, appendicitis is rare under age 2 and most common between ages 10 and 30.

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Who gets appendicitis?

Appendicitis is common and can affect anyone of any age. Teenagers and young adults are the most commonly affected. It is slightly more common in men than in women. It is much more common in western countries. This is thought to be partly due to the western diet which is often low in fibre.

What causes appendicitis?

Appendicitis: Symptoms, Causes, Pain, Surgery, Recovery and Treatment
Appendicitis means inflammation of the appendix. It is thought that appendicitis begins when the opening from the appendix into the cecum becomes blocked. The blockage may be due to a build-up of thick mucus within the appendix or to stool that enters the appendix from the cecum. The mucus or stool hardens, becomes rock-like, and blocks the opening. This rock is called a fecalith (literally, a rock of stool). At other times, it might be that the lymphatic tissue in the appendix swells and blocks the opening. After the blockage occurs, bacteria which normally are found within the appendix begin to invade (infect) the wall of the appendix. The body responds to the invasion by mounting an attack on the bacteria, an attack 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, for example, inflammation.

If the inflammation and infection spread through the wall of the appendix, the appendix can rupture. After rupture, infection can spread throughout the abdomen; however, it usually is confined to a small area surrounding the appendix (forming a peri-appendiceal abscess).

Sometimes, the body is successful in containing ("healing") the appendicitis without surgical treatment if the infection and accompanying inflammation do not spread throughout the abdomen. The inflammation, pain and symptoms may disappear. This is particularly true in elderly patients and when antibiotics are used. Patients then may come to the doctor long after the episode of appendicitis with a lump or a mass in the right lower abdomen that is due to the scarring that occurs during healing. This lump might raise the suspicion of cancer.

What are the symptoms of appendicitis?

Pain in the abdomen (tummy pain) is usually the main symptom

The main symptom of appendicitis is abdominal pain. The pain is at first diffuse and poorly localized, that is, not confined to one spot. (Poorly localized pain is typical whenever a problem is confined to the small intestine or colon, including the appendix.) The pain is so difficult to pinpoint that when asked to point to the area of the pain, most people indicate the location of the pain with a circular motion of their hand around the central part of their abdomen. A second, common, early symptom of appendicitis is loss of appetite which may progress to nausea and even vomiting. Nausea and vomiting also may occur later due to intestinal obstruction.
Appendicitis: Symptoms, Causes, Pain, Surgery, Recovery and Treatment

As appendiceal inflammation increases, it extends through the appendix to its 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 localized clearly to one small area. Generally, this area is between the front of the right hip bone and the belly button. The exact point is named after Dr. Charles McBurney--McBurney's point. If the appendix ruptures and infection spreads throughout the abdomen, the pain becomes diffuse again as the entire lining of the abdomen becomes inflamed.

Typically the pain becomes worse and worse over 6-24 hours. The pain may become severe. The pain tends to be more sharp if you cough or make any jarring movements. The pain may ease a bit if you pull your knees up towards your chest. The lower abdomen is usually tender, particularly in the lower right-hand side.

Other symptoms of Appendicitis that may occur include the following.

  • Feeling sick and being off food is typical. You may vomit.
  • Fever and generally feeling unwell.
  • Constipation may occur. Sometimes diarrhoea.
  • Frequent passing of urine may develop. This is thought to be due to the inflammation irritating the nearby ureter (the tube between the kidney and bladder).
If the appendix perforates (bursts) then severe pain can spread to all the abdomen. You also become very ill. 

In some cases, the symptoms are not so typical. For example, in some cases the pain may develop more slowly and run a more smouldering course. The pain may also start in the lower right-hand side of the abdomen. Also, the pain may not become severe until the appendix perforates. The site of the pain may not be typical if the appendix lies in an unusual place.

How Is Appendicitis Diagnosed?

Appendicitis: Symptoms, Causes, Pain, Surgery, Recovery and Treatment
Diagnosing appendicitis can be tricky. Symptoms of appendicitis are frequently vague or extremely similar to other ailments, including gallbladder problems, bladder or urinary tract infection, Crohn's disease, gastritis, intestinal infection, and ovary problems.

The following tests are usually used to make the diagnosis.
  • Abdominal exam to detect inflammation
  • Urine test to rule out a urinary tract infection
  • Rectal exam
  • Blood test to see if your body is fighting infection
  • CT scans and/or ultrasound

Why can it be difficult to diagnose appendicitis?

It can be difficult to diagnose appendicitis. The position of the appendix in the abdomen may vary. Most of the time the appendix is in the right lower abdomen, but the appendix, like other parts of the intestine, has a mesentery. This mesentery is a sheet-like membrane that attaches the appendix to other structures within the abdomen. If the mesentery is large, it allows the appendix to move around. In addition, the appendix may be longer than normal. The combination of a large mesentery and a long appendix allows the appendix to dip down into the pelvis (among the pelvic organs in women). It also may allow the appendix to move behind the colon (called a retro-colic appendix). In either case, inflammation of the appendix may appear to be more like the inflammation of other organs, for example, a woman's pelvic organs.

The diagnosis of appendicitis also can be difficult because other inflammatory problems may mimic appendicitis. Therefore, it is common to observe patients with suspected appendicitis for a period of time to see if the problem will resolve on its own or develop characteristics that more strongly suggest appendicitis or, perhaps, another condition.

How Do I Know If I Have Appendicitis?

Diagnosing appendicitis can be tricky: Time is critical, yet symptoms are frequently vague or extremely similar to other, less urgent ailments, such as bladder infection, colitis, Crohn's disease, gastritis, gastroenteritis, and ovary problems. 

Appendicitis can often be diagnosed by your doctor gently pressing on your lower right abdomen, which will be the maximum point of tenderness. A urine test will also be performed to rule out a urinary tract infection. Appendicitis can cause rectal pain instead of abdominal pain, so your doctor will also examine your rectum by inserting a lubricated, gloved finger. A blood test will show if your white blood cell count is elevated, an indication that your body is fighting infection. CT scans and ultrasound are fast and reliable -- though not perfect -- in revealing appendicitis.

What are the complications of appendicitis?

The most frequent complication of appendicitis is perforation. Perforation of the appendix can lead to a peri-appendiceal abscess (a collection of infected pus) or diffuse peritonitis (infection of the entire lining of the abdomen and the pelvis). The major reason for appendiceal 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 at least 15%. Therefore, once appendicitis is diagnosed, surgery should be done without unnecessary delay.
Appendicitis: Symptoms, Causes, Pain, Surgery, Recovery and Treatment

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. It then may be necessary to drain the contents of the intestine through a tube passed through the nose and esophagus and into the stomach and intestine.

A feared complication of appendicitis is sepsis, a condition in which infecting bacteria enter the blood and travel to other parts of the body. This is a very serious, even life-threatening complication. Fortunately, it occurs infrequently.

How is appendicitis treated?

Once a diagnosis of appendicitis is made, an appendectomy usually is performed. Antibiotics almost always are begun prior to surgery and as soon as appendicitis is suspected.
Appendicitis: Symptoms, Causes, Pain, Surgery, Recovery and Treatment

There is a small group of patients in whom the inflammation and infection of appendicitis remain mild and localized to a small area. The body is able not only to contain the inflammation and infection but to resolve them as well. These patients usually are not very ill and improve during several days of observation. This type of appendicitis is referred to as "confined appendicitis" and may be treated with antibiotics alone. The appendix may or may not be removed at a later time.

On occasion, a person may not see their doctor until appendicitis with rupture has been present for many days or even weeks. In this situation, an abscess usually has formed, and the appendiceal perforation may have closed over. If the abscess is small, it initially can be treated with antibiotics; however, an abscess usually requires drainage. A drain (a small plastic or rubber tube) usually is inserted through the skin and into the abscess with the aid of an ultrasound or CT scan that can determine the exact location of the abscess. The drain allows pus to flow from the abscess out of the body. The appendix may be removed several weeks or months after the abscess has resolved. This is called an interval appendectomy and is done to prevent a second attack of appendicitis.

Recovery and Recommended Diet for Appendicitis

Recovery Time for Appendicitis

In most cases, recovery time for Appendicitis surgery is relatively short. You will be normally allowed to leave the hospital after 1 – days after the surgery. To get back to normal activities, you may need 2 to 4 weeks depending on the conditions.
Appendicitis: Symptoms, Causes, Pain, Surgery, Recovery and Treatment

If surgeon only makes small incision in the belly area during the surgery, you should be able to recover soon and immediately return to normal daily activities. In case the appendix is broken before or during the surgery, recovery time will be longer than usual. Of course, the recovery time is heavily affected by the existence of other possible complications.

Appendicitis Complications

Appendicitis recovery time is as well affected by the existence of complications. One of the most frequently encountered complications is infection of the surgical incision. In case of mild to moderate infection, you will be required to take antibiotics treatment. If severe infection occurs, antibiotics and further surgical procedures are necessary.

At times, the incision will not be closed immediately after the surgical procedures are completed. Surgeons may consider the infection of appendix is so severe; the surgical closing will have to be postponed until the infections subside. In the mean time, antibiotics treatment is given.

Another possible complication is the formation of abscess during the surgery. Occasionally, abscess is found before Appendicitis; in such situation, the accumulation of pus needs to be drained before the surgery can be performed. It may take weeks to months for a complete removal of abscess because surgeons will perform Appendicitis after the drainage is completed.

If the accumulation of pus is found after the appendectomy, another surgical procedure is necessary. The surgery may involve a tiny tube inserted into the body. Immobility is a common issue associated with such procedure. If severe complications appear, recovery time will be normally longer as well.

Appendicitis Recovery Diet

1. Liquids and foods which are easy to digest 

 To quicken the recovery process, it is recommended that you take certain types of diet program. Resuming to normal diet immediately after the surgery is not suggested. In most cases, solid liquid and foods should be avoided.

The most important thing is that you should only consume liquids and foods which are easy to digest. This diet restriction can accommodate the effects of anesthesia such as nausea and vomiting. Some of the most recommended clear liquids are gelatin, clear broth, and fruits without pulp.

Low-residue foods (types of foods that do not leave undigested substances in the colon) are as well good. You may need to consult doctors concerning the best types of foods to consume.

2. Bland foods
Another dietary recommendation is to consume bland foods. They are foods that do not have interesting or strong taste. Avoiding spicy or greasy foods will help to prevent gastrointestinal distress. Bland foods include rice, potatoes, or cooked chicken.

It is also necessary to avoid foods that produce intestinal gas, for example beans. Especially for laparoscopic appendectomy, surgeons fill the abdomen with air during the surgery; eating foods, which produce intestinal gas, will only increase the pain.

3. High fiber foods
Another common post-surgical issue is constipation. To accommodate this issue, high fiber foods are recommended. Of course, you will need to slowly add such foods to the dietary menu as a part of appendectomy recovery process.

Immediately resuming to high fiber foods after appendectomy will possibly increase or develop uncomfortable intestinal gas pain. Once again, it is recommended to consult to your doctors concerning the best dietary program following an appendectomy procedure.