Appendicitis means inflammation of the appendix.
The inflamed appendix becomes infected with bacteria (germs) in the intestine, gradually swells and fills with pus.
If left untreated, the swollen appendix is ​​at risk of perforation.
This is very serious because the contents of the intestine escape into the abdominal cavity.

This can cause a severe infection of the membrane lining the abdomen ( peritonitis ) or an abscess in the abdomen. Therefore, when appendicitis is suspected, early treatment is essential prior to perforation.
It usually affects children, but rarely also affects the elderly.


What is the appendix and where is it?

The appendix is ​​a small pouch, like a small tube that originates in the bowel of the cecum. The cecum is the first part of the large intestine before the colon. The small intestine digests and absorbs food. Parts of food that are not digested form faeces in the bowel of the cecum.
The appendix is ​​about 5 to 10 cm long and is very thin.
We do not know the utility of the appendix.


Stages of appendicitis

The stages of appendicitis can be divided into suppurative, perforated, gangrenous, phlegmonous, spontaneous, chronic and recurrent resolution.

Appendicitis in the early phase – in the early phase of appendicitis, obstruction of the appendix causes inflammation and ulceration of the mucosa, in addition to relaxation due to accumulated fluid.
The patient feels a slight  belly pain around the navel that lasts for about four to six hours.

Suppurative appendicitis  – Increased internal pressure exceeds capillary pressure.
Lymphatic and venous drainage are blocked and this favors invasion of bacteria and inflammation of the appendix wall.
Bacterial invasion through the wall causes acute suppurative appendicitis.
The pain moves from the center of the abdomen to the right side of the abdomen at the bottom and becomes very intense.

Perforated appendicitis – Persistent ischemia causes tissue infarction and perforation of the appendix. Perforation can cause localized or generalized peritonitis.

Phlegmonous appendicitis or focal abscess – Phlegmonous appendicitis or focal abscess occurs when the inflamed or perforated appendix separates from the adjacent large omentum or intestine and forms pus within the appendix and walls.

Gangrenous appendicitis – arterial and venous thrombosis occurs inside the appendix, gangrene is formed due to absence or reduction of blood flow.

Spontaneous resolution – if the obstruction is relieved, acute appendicitis can resolve itself. This occurs if the cause of the symptoms is lymphoid hyperplasia or when a mass of feces is expelled from the intestinal lumen.
In this case it should not be operated.

Recurrent appendicitis – The incidence of recurrent appendicitis is 10 percent.

Chronic appendicitis occurs at an incidence of 1 percent and has the following characteristics:
Chronic appendicitis is an inflammation of the appendix that can last for weeks, months or even years.
There are conflicting opinions, but the symptoms of appendicitis (especially lower right abdominal pain ) may disappear, but you may have them again in the future.
Sometimes abdominal pain is the only symptom of people with chronic appendicitis, so it is crucial to rule out other diseases such as iliopsoas muscle contraction or gynecological conditions (eg, an ovarian cyst or salpingitis ).
In other cases, people may have typical symptoms of acute appendicitis, among these are nausea, fever and diarrhea.


What are the symptoms of appendicitis?

The classic symptoms of appendicitis include:

Almost half the time, other symptoms appear, including:

The location of the pain may vary depending on the age and location of the appendix. Children or pregnant women, especially, there may be appendicitis pains in different places.
There are some variations in the position of the appendix: pelvic, retrocecal, subhepatic, meso-celiac.

Symptoms vary and may be confused with other sources of abdominal pain, including:

What are the causes of appendicitis?

The obstruction of the appendicular entry causes appendicitis. The mucus accumulates in the appendix causing the multiplication of bacteria that normally live in the appendix.
As a result, the appendix swells and becomes infected. The origins of obstruction include:

  • Stools, parasites or growths that obstruct the opening between the appendix and the intestine,
  • Swollen lymph nodes in the wall of the appendix,
  • Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis,
  • Trauma in the abdomen.

An inflamed appendix could puncture if not removed. The rupture spreads the infection throughout the abdomen, a potentially deadly condition called peritonitis.

My son has an upset stomach. Can it be appendicitis?

Appendicitis is very rare in young children, but it is possible.
Appendicitis can be difficult to diagnose for parents.
At first it may seem like intestinal flu or gastroenteritis .
The classic symptoms are abdominal pain, fever and vomiting. (In rare cases, it can also cause diarrhea).

The baby’s abdomen may be distended and sensitive to pressure, it may limp or remain bent to the right side, although the inflamed appendix irritates the leg muscles.

Another telltale sign  (though usually not present until school age) is pain that begins near the navel, then worsens and moves toward the lower right part of the abdomen. Depending on the child’s age and verbal skills, he may be able to describe this malady.
Children may report the need to urinate often .


What are the complications of appendicitis?

If the appendix ruptures and releases the infected substances in the patient’s abdomen, peritonitis may develop. The peritoneum becomes inflamed. The peritoneum is the membrane of the abdominal cavity and covers most of the abdominal organs.
Peritonitis causes the closure of the intestine, intestinal peristalsis to and blocks the intestine. The fever appears and the patient may go into shock. Peritonitis is a disease that must be treated immediately because it can cause death.

If the infection comes out of the appendix and mixes with the intestinal contents, it may form an abscess .
If the abscess is not treated it can cause peritonitis. Sometimes abscesses are treated with antibiotics .
They are often surgically drained with the help of a tube that is inserted into the abdomen.

How is appendicitis diagnosed?

It can be difficult to diagnose appendicitis. The symptoms of appendicitis are often vague or extremely similar to other diseases including gallbladder problems, urinary tract or bladder infection, Crohn’s disease, intestinal infection and problems in the ovary.
The following tests are usually done to make the diagnosis.

1. Abdominal examination to detect inflammation.
The patient has a throbbing pain and contracts the muscles for defense, so it is very difficult to palpate the abdomen.
2. Urinalysis to rule out a urinary tract infection;
3. Rectal examination;
4. Blood test to see if the body is fighting an infection, so white blood cells and  erythrocyte sedimentation rate (ESR) or sedimentation rate are very high.
5. Computed tomography and / or  ultrasonography

A physical examination with a physical examination is essential.
Unfortunately today many doctors have lost the habit of consulting patients and simply checking the imaging tests (CT, MRI, etc.).
In this way, they often lose time because the tests do not show everything, so they can not see if a muscle is contracted or if the texture is normal or altered.

The details about abdominal pain are foremost to diagnose appendicitis. The doctor evaluates the pain by applying pressure to specific areas of the abdomen.
Responses that may indicate appendicitis include:

A defense contraction occurs when a person unconsciously hardens the abdominal muscles during the examination.
Involuntary defense occurs when the doctor’s hand touches the abdomen.
In fact, the involuntary defense contraction occurs before the doctor comes in contact with the patient.
To solve this problem it is necessary to gently support the hand in the abdomen and wait for the patient to relax.

Bounce Pain
A physician evaluates rebound pain by applying pressure of the hand on the patient’s abdomen and then removing it. Pain after release of pressure indicates rebound pain. A person may feel this symptom even if the abdomen is injured – for example, when a person suffers a blow.

Rovsing Maneuver
The medical examination for the Rovsing sign is done by applying pressure of the hand on the left side of the lower abdomen.
The pain in the lower right side of the abdomen after release of pressure on the left side indicates the presence of Rovsing’s signal.
This is a specific test for appendicitis.

Psoas test
The psoas muscle originates from the lumbar vertebra and is inserted into the femur. In its course it passes through the pelvis, near the appendix. If this muscle is contracted it causes abdominal pain where the appendix is ​​inflamed.
For this examination the patient should lie down with his belly up.
The doctor can check the status of the psoas considering whether the left knee automatically lifts when the patient tries to bring the right knee toward the chest.
This muscle is often contracted in people with poor diet because of their location.
In the right part of the abdomen, there are organs that lean above the psoas: liver, intestine and the appendix.
If these organs are thickened or heavy, the right psoas muscle should make a great effort to counter the pressure of the organs.

Shutter Testing
The right obturator muscle originates near the appendix. The medical examination for the obturator is done by asking the patient to lie down with his right knee bent.
Moving the bent knee to the right and left causes contraction of the obturator muscle and causes abdominal pain where the appendix is ​​inflamed.

Women of childbearing age should undergo a pelvic exam to exclude gynecological diseases that sometimes cause abdominal pain such as appendicitis.
The doctor can also examine the challenge.

What is the treatment for appendicitis?

The doctor may decide to treat the patient with antibiotics . This treatment is rare and the infection should be mild. In most cases an appendectomy surgery is done, ie the appendix is ​​removed surgically.

What to eat?

Diet is important in the prevention and treatment of appendicitis.
The same diet can be followed for colitis , it is best to avoid certain foods:

  • Chocolate e nutella
  • Spicy foods
  • Salame
  • Fermented and greasy cheese
  • Fish and fatty meat, crustaceans (Cameroon, lobsters and crabs)
  • Processed cakes
  • Coffee, tea and other beverages containing caffeine
  • Soft drinks, cocktails and drinks.

Laparoscopy (guided surgery)

Laparoscopic surgery is also known as minimally invasive surgery. The surgeon inserts a thin tube (laparoscope) that has a camera and a lumen in the abdomen

With a small camera the surgeon can see the inside of the abdomen with a magnification of the image on a monitor.
The small instruments respond to the movements of the hands of the surgeon and the appendix is ​​removed through small abdominal incisions.

Thanks to the precision of this surgery, the blood loss is minimal and with the small incisions the patient recovers much faster and with fewer scars compared to the traditional open surgery.
In most cases it is not necessary to make a large incision in the patient’s abdomen.

Three small cuts are made to remove the appendix. The advantage of minimally invasive surgery is that the scar is minimal and the recovery time is short.

Most people can leave the hospital within a few days after the operation, to recover fully serve a week or two.

However, a report from the American College of Surgeons says that traditional open appendectomy may be preferable to laparoscopic appendectomy for most patients with acute appendicitis, in contrast to recent trends.
Laparotomy surgery  increases costs and may increase the risk of complications in most patients.

Traditional open surgery

If the appendix has burst and the infection has spread or if there is an abscess, a larger incision may be made to clean the inside of the abdominal cavity.
Traditional appendectomy is also used if the patient has a cancer of the digestive system, if a woman is in her third trimester of pregnancy or if the patient has had several abdominal surgeries.
After the operation, the patient takes antibiotics intravenously.
After appendectomy the recovery times of the surgery are typically 2-3 weeks and hospitalization (hospitalization) lasts for 2-3 days.

Before and after surgery, antibiotics and intravenous fluids can help prevent complications and decrease the risk of wound infection after surgery.
If necessary, the doctor may prescribe an analgesic medication to the child.
An infected appendix that bursts should be removed surgically, but may serve a longer hospital stay to allow antibiotics to kill all bacteria that have spread throughout the body.

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