Appendicitis

Symptoms Of Appendicitis

The most important symptom of appendicitis is:

• Sudden pain that starts around the belly button and frequently moves to the lower right abdomen. 
• Initially, the pain is diffused and not confined to one spot. Most individuals indicate the location of the pain with a circular motion of their hand around the central part of their abdomen.
• With time, the pain may get localized to the right lower abdomen, and the patient may be able to pinpoint the exact location of the pain.

Other symptoms of the condition include:

• Loss of appetite
• Nausea
• Vomiting
• Constipation
• Diarrhea
• Bloating 
• Indigestion
• Swelling in the abdomen
• Abdominal pain that becomes worse as you cough, sneeze, walk, or perform other actions
• Low-grade fever with chills
• Inability to pass gas
• Painful and frequent urination
• Difficulty rising from lying position
• Anxiety
• Headache
• Dizziness
• Anorexia (an eating disorder where the individual do not eat to avoid weight gain)

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Causes Of Appendicitis

The cause of appendicitis is usually blockage of the opening of the appendix. The potential causes of blockage include:

• Appendicoliths (hardened rock-like mucus or stools) 
• Lymphatic tissue growth
• Infections
• Benign or malignant tumors
  
  

As the blockage occurs, bacteria that are normally found within the appendix begin to multiply and invade the wall of the appendix. The body's immune response to this bacterial invasion results in inflammation of the appendix.

Types of Appendicitis

Appendicitis can be classified based on its onset into the following types:

Acute appendicitis

It begins with normal abdominal pain and then pain migrates to the lower right abdomen. The pain intensifies very fast within a few days to hours. It requires immediate medical attention or surgery, as it can develop more fatal complications if left untreated.

Chronic appendicitis

When inflammation of the appendix lasts for a longer duration, it is termed chronic appendicitis. The symptoms are milder than disappear and reappear constantly. Sometimes, this makes it challenging for doctors to diagnose it early.

Risk Factors Of Appendicitis

Appendicitis can affect anyone. But some people may be more likely to develop this condition than others which includes the following factors:

• Age: The majority of appendicitis cases occur during 20s and 30s.
• Gender: Males are more prone to develop appendicitis than females.
• Family history: People with a family history of appendicitis are more likely to develop it.
• Constipation: Prolonged constipation can block the appendix which can lead to appendicitis.

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• Other conditions: Chronic bowel diseases such as Crohn’s disease or ulcerative colitis can increase the chances of getting appendicitis.
• Air pollution: Research demonstrates a link between air pollution and increased risk of appendicitis. It might be possible because air pollution can increase the susceptibility to bacterial and viral infections and can increase intestinal inflammation.

Diagnosis Of Appendicitis

The symptoms of appendicitis are very similar to many other conditions. So, it is essential to distinguish between these diseases through specific clinical tests along with physical examination. They include:

Medical history

A detailed medical history is taken to rule out the possibility of other health conditions. A history of abdominal pain for the last 12-24 hours without fever or diarrhea that migrates to the lower right side of the stomach along with tenderness. You might be asked about the starting of your symptoms, along with ongoing medicines for any other disease.

Physical examination

To diagnose appendicitis, your doctor will perform a physical test. You might be asked to pinpoint the area of the abdomen where you feel the pain. The doctor will apply gentle pressure on the painful area to check the abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix.

Note: The physical examination may be unrevealing in the very early stages of appendicitis and the signs and symptoms might be subtle.

Imaging tests

These tests show whether the abdominal pain is caused by any obstruction inside the appendix, an enlarged or burst appendix, inflammation, an abscess, or something else. They include:

• Abdominal ultrasound: Abdominal ultrasonography uses sound waves to produce an image of internal organs, without the use of X-rays or radiation.  It is a widely used primary measure to evaluate patients with acute abdominal pain. 

• Abdominal Computerized tomography (CT): CT scans use X-rays to produce internal images. An abdominal CT scan has greater than 95% accuracy for the diagnosis of appendicitis.

• Abdominal Magnetic resonance imaging (MRI): MRI Scan uses strong magnetic and radio waves to create detailed and clear 3D images of the body's internal organs. However, performing an abdominal MRI is expensive and also demands a high level of expertise to interpret the results.

Note: In order to reduce radiation exposure, it is recommended for pregnant women and children to undergo an ultrasound or MRI instead of a CT scan.

• Abdominal x-rays: Abdominal X-rays do not have a role in diagnosis of acute appendicitis, but in some cases appendicoliths may be visible on it.

• Barium enema test: This can assist in identifying appendicitis in patients with atypical symptoms. It can detect signs of inflammation in the appendix, as well as other abnormalities in the colon or pelvis. 

Laboratory tests

• Complete blood count (CBC): Your doctor will recommend a CBC to check for a high white blood cell count, which could be a sign of infection. 
  
• C-reactive protein test: This test is recommended to check any other causes of abdominal inflammation such as autoimmune disorders.
  
• Urine and stool test: Urinalysis and stool test is done for diagnosis of any infection, inflammation, kidney stone that is causing pain.

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Other tests

Diagnostic laparoscopy: It is a medical procedure used by doctors to visually examine the abdomen and pelvis when other imaging techniques are not able to identify the cause of pain or growth in these areas. 

Prevention Of Appendicitis

One of the major risk factors for appendicitis is constipation. Though appendicitis cannot be prevented there are certain dietary modifications that can prevent constipation.

Foods to eat

• Fresh fruits like apple, orange, lime, strawberries, papaya, banana,  muskmelon, guava, pineapple, mango, blueberries, avocado, apricots, & peaches.
• Legumes like green gram, lentils, sprouts, yellow lentils, green lentils, & chickpeas.
• Vegetables like carrot, ladyfinger, bottle gourd, snake gourd, beetroot, cucumber, potatoes, capsicum, cauliflower, squashes, green leafy vegetables, kale, spinach, cabbage & beetroot.
• Whole wheat flour
• Brown rice

Foods to avoid

• Processed, packaged, fried, and junk foods 
• All purpose flour (maida)
• Red meat 
• Cakes, pastries, and other sugary items 
• Carbonated drinks & canned packed juices.

Note: Remember to get adequate water intake, regular exercise, and keep an arm's distance from alcohol consumption and smoking.

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Specialist To Visit

The doctors who can assess the severity of the patient and formulate a treatment plan include:

• General physician
• Gastrointestinal (GI) specialist
• General surgeon
  
  

Your general physician will examine your symptoms and abdomen. If they confirm a diagnosis, they may refer you to a specialist who can perform surgery to remove the appendix and prevent future problems. This specialist may be a gastrointestinal specialist or a general surgeon, both of whom have the expertise to perform appendectomy (Appendix removal).

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Treatment Of Appendicitis

The most effective and common treatment for appendicitis is surgical removal of the appendix. The exact function of the appendix is unknown and the best and safest option to treat an inflamed appendix is its removal. However, studies also show that certain cases can be managed through non-surgical options. Management of appendicitis include:

Surgical management

Treatment of appendicitis generally involves surgery to remove the inflamed appendix, which is known as appendectomy Surgery to remove your appendix can be performed in the following ways:

• Open appendectomy: It is a surgical procedure in which a single 5-10 centimeters long incision in the lower-right abdominal area removes an appendix. This type of appendectomy is suggested if the appendix has ruptured and the infection has spread.

• Laparoscopic appendectomy: The surgeon makes up to three tiny incisions in the belly to insert a laparoscope, which is a camera and light attached to a thin tube that allows the surgeon to observe the abdomen internally. After identifying the appendix, it is stitched up and removed. Laparoscopic procedures are preferred due to fewer complications and a quicker recovery period.

Here are a few tips to follow post-surgery. Post-operative care includes:

• Keep the incision site clean with water and gentle soap
• Change the dressing as and when suggested by the doctor
• Limit your physical activity and do not lifting any heavy objects
• Drink plenty of water and fluids and adding more fiber to ease constipation
• Do not strain the abdominal muscles by climbing stairs or doing exercise that involves stomach 
• Ask your doctor about when is safe to return to your regular job, and about the follow up visits
• Keeping a check on your symptoms. Contact your doctor immediately if you experience severe pain, fever, and pus formation near your incision or severe vomiting.

Medications

1. Most treatment strategies include an initial course of intravenous antibiotics for 1-3 days, followed by oral antibiotics for 7 days.The most common antibiotics used are:

• Cefotaxime
• Ampicillin
• Sulbactam

2. Some analgesics (painkillers) such as acetaminophen may be given to manage severe pain. 

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Home-care For Appendicitis

Acute appendicitis is a sudden medical issue that requires urgent treatment and surgery.. However, the following natural and herbal remedies may help alleviate the symptoms associated with appendicitis:

• Ginseng tea: Ginseng possesses anti-oxidant and anti-inflammatory properties. It can help relieve pain associated with appendicitis.
• Mint essence: May be able to lessen the discomfort associated with appendicitis. Every three to four hours, add 2 to 3 drops of mint essence to water and consume.
• Basil (Tulsi): If the appendicitis patient has a fever, basil leaves can be used to make a decoction because they have antipyretic properties 
• Fenugreek (Methi): High fiber content of fenugreek may aid in reducing constipation, which makes it potentially useful in managing appendicitis.
• Yogurt (Dahi): Probiotics like yogurt may prove effective in preventing bacterial growth in the appendix. Therefore consuming 2 tablespoons of yogurt once a day is beneficial as it treats inflammation and pain to a huge extent.
• Ginger (Adrak): It is famous for its therapeutic benefits. Its anti-inflammatory and detoxifying properties have the potential to provide major health benefits. Mix 1 teaspoon (tsp) of ginger juice, half a tsp of turmeric, and 1 tsp of honey. Drink this mixture twice a day. This may help you to reduce swelling, nausea, and other symptoms of appendicitis.

Complications Of Appendicitis

The serious problem with appendicitis is the risk of a bursting appendix and causing life-threatening infections. This may happen if the appendix is not treated and removed quickly and can cause complications, including:

• Peritonitis: After the appendix bursts, the thin layer of tissue inside the abdomen becomes swollen and infected with bacteria. This can cause severe, continuous pain in the whole abdomen, known as peritonitis.

• Abscess: An abscess is a painful collection of pus around the ruptured appendix that is usually caused by a bacterial infection. It is managed with antibiotics to clear the infection and surgical drainage of pus.

• Sepsis: Pus and infection caused by a ruptured abscess might travel through the bloodstream to other body parts. It is a rare but severe condition that can lead to tissue damage, organ failure, and death.

• Thrombophlebitis: It is an uncommon and serious illness involving the inflammation of the wall of a vein associated with a blood clot. 

• Appendicular mucocele: This refers to a swollen appendix filled with mucus, which is usually caused by the growth of cells, inflammation, or blockage.

• Recurrent appendicitis: It is seen when the appendix is only partially removed resulting in recurrent inflammation of the remaining appendix.

Complications post-surgery

After the removal of the appendix, certain complications can arise, which include:

• Healing with scar formation

• Intestinal adhesion and obstructions